Provider Demographics
NPI:1174021281
Name:INSIGHT RECOVERY CEDAR CITY LLC
Entity Type:Organization
Organization Name:INSIGHT RECOVERY CEDAR CITY LLC
Other - Org Name:LIONS GATE RECOVERY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-718-3935
Mailing Address - Street 1:260 W SAINT GEORGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3792
Mailing Address - Country:US
Mailing Address - Phone:801-718-3935
Mailing Address - Fax:
Practice Address - Street 1:535 S MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-3576
Practice Address - Country:US
Practice Address - Phone:801-718-3935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIONS GATE RECOVERY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT53345261QM0850X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health