Organization
SECOND NATURE ENTRADA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGIE EVANS (BUSINESS OFFICE)
(801) 766-6604
Entity
Organization
Contact information
Practice address
2711 SANTA CLARA DR STE 400, SANTA CLARA, UT 84765-5480
(435) 674-9310
Mailing address
2711 SANTA CLARA DR STE 400, SANTA CLARA, UT 84765-5480
(435) 674-9310
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
17943
UT
323P00000X
Psychiatric Residential Treatment Facility
17943
UT
Other
Enumeration date
06/02/2008
Last updated
05/29/2012
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