| Doctor Name: | DANIEL EDMUND BANELLIS |
| NPI Number: | 1194087015 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 411 Grant St Salt Lake City, UT - 841162725 |
| Business Phone Number: | 8013598862 |
| Business Fax Number: | 8013598510 |
| Mailing Address: | 400 North 1756 West, Apt 56b, SALT LAKE CITY |
| State: | UT |
| Postal Code: | 84116 |
| Phone Number: | 8013598862 |
| Fax Number: | 8013598510 |
| NPI Enumeration Date: | 06/15/2012 |
| NPI Last Update Date: | 06/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 324500000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |