Provider Demographics
NPI:1124593108
Name:WHITE SAGE RECOVERY, INC.
Entity Type:Organization
Organization Name:WHITE SAGE RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:801-885-6341
Mailing Address - Street 1:533 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2215
Mailing Address - Country:US
Mailing Address - Phone:801-899-2460
Mailing Address - Fax:801-899-2459
Practice Address - Street 1:533 W CENTER ST
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2215
Practice Address - Country:US
Practice Address - Phone:801-899-2460
Practice Address - Fax:801-899-2459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility