Provider Demographics
NPI:1184011397
Name:ADDICTION RECOVERY SERVICES
Entity Type:Organization
Organization Name:ADDICTION RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-830-2915
Mailing Address - Street 1:175 S MAIN ST
Mailing Address - Street 2:512
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1916
Mailing Address - Country:US
Mailing Address - Phone:801-830-2915
Mailing Address - Fax:
Practice Address - Street 1:175 S MAIN ST
Practice Address - Street 2:SUITE 512
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1916
Practice Address - Country:US
Practice Address - Phone:801-830-2915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-25
Last Update Date:2015-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6854100-6006261QM0850X
UT6854100-6004261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health