Organization
ACQUA RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLINT TOLMAN (ADMINISTATOR)
(954) 634-4425
Entity
Organization
Contact information
Practice address
3940 N TRAVERSE MOUNTAIN BLVD, LEHI, UT 84043-4914
(954) 634-4425
Mailing address
1031 S DOUGLAS ST, SALT LAKE CITY, UT 84105-1505
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
20785
UT
Other
Enumeration date
02/03/2016
Last updated
02/03/2016
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