| Organization Name: | SAN JUAN MENTAL HEALTH-SUBSTANCE ABUSE SSD |
| NPI Number: | 1790898526 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAN S. ROGERS (EXECUTIVE DIRECTOR) |
| Mailing Address: | 356 S Main St Blanding |
| State: | UT US |
| Postal Code: | 845113830 |
| Phone Number: | 4356782992 |
| Fax Number: | 4356783116 |
| NPI Enumeration Date: | 08/16/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0405X |
| License Number: | 11054 |
| 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: | |