Doctor Name: | CURTIS BRYANT BLACKHAM |
NPI Number: | 1235425109 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 272503815 |
Business Practice Address: | 21260 N 1450 E Moroni, UT - 846460461 |
Business Phone Number: | 4354455200 |
Business Fax Number: | 4354455201 |
Mailing Address: | Po Box 461, 21260 N 1450 E MORONI |
State: | UT |
Postal Code: | 846460461 |
Phone Number: | 4354455200 |
Fax Number: | 4354455201 |
NPI Enumeration Date: | 06/20/2011 |
NPI Last Update Date: | 06/20/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 324500000X |
License Number: | 272503815 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
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. |