Provider Demographics
NPI:1073662284
Name:CARE TREATMENT AND RECREATION
Entity Type:Organization
Organization Name:CARE TREATMENT AND RECREATION
Other - Org Name:CTR
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HEADMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-699-8765
Mailing Address - Street 1:2057 MEADOWLARK WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093
Mailing Address - Country:US
Mailing Address - Phone:801-699-8765
Mailing Address - Fax:
Practice Address - Street 1:2057 MEADOWLARK WAY
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093
Practice Address - Country:US
Practice Address - Phone:801-699-8765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities