Organization
MAPLE LAKE ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARGO L VANE (OFFICE MANAGER)
(801) 798-7700
Entity
Organization
Contact information
Practice address
6155 S 2400 W, SPANISH FORK, UT 84660-4606
(801) 798-7700
Mailing address
6155 S 2400 W, SPANISH FORK, UT 84660-4606
(801) 798-7700
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
18290
UT
Other
Enumeration date
05/02/2012
Last updated
05/02/2012
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