Organization Name: | PINES RECOVERY CENTER |
NPI Number: | 1114310497 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DUANE M CONNER (OWNER) |
Mailing Address: | 425 Moulton Ln Heber City |
State: | UT US |
Postal Code: | 840323843 |
Phone Number: | 8016084557 |
Fax Number: | |
NPI Enumeration Date: | 03/11/2015 |
NPI Last Update Date: | 03/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0405X |
License Number: | 11014 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
Taxonomy Definition: |