Provider Demographics
NPI:1003427923
Name:PAINTED DESERT RECOVERY LLC
Entity Type:Organization
Organization Name:PAINTED DESERT RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:435-272-2193
Mailing Address - Street 1:461 N 2300 WEST CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7374
Mailing Address - Country:US
Mailing Address - Phone:435-272-2193
Mailing Address - Fax:
Practice Address - Street 1:1947 S 2800 E
Practice Address - Street 2:
Practice Address - City:NEW HARMONY
Practice Address - State:UT
Practice Address - Zip Code:84757-5115
Practice Address - Country:US
Practice Address - Phone:435-272-2193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder