| Organization Name: | CIRQUE LODGE INC. |
| NPI Number: | 1912108242 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GARY FISHER (DIRECTOR OF OPERATIONS) |
| Mailing Address: | 1240 East 800 North Orem |
| State: | UT US |
| Postal Code: | 84097 |
| Phone Number: | 8012229200 |
| Fax Number: | |
| NPI Enumeration Date: | 05/31/2007 |
| NPI Last Update Date: | 06/30/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 324500000X |
| License Number: | 12370 |
| 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. |