Organization
ACQUA RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLINT TOLMAN (DIRECTOR)
(954) 678-0078
Entity
Organization
Contact information
Practice address
100 N JOHNSON MILL RD, MIDWAY, UT 84049-6764
(954) 678-0078
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
13414
UT
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
13415
UT
324500000X
Substance Abuse Rehabilitation Facility
10218
UT
Other
Enumeration date
04/07/2015
Last updated
04/07/2015
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