Provider Demographics
NPI:1235444787
Name:ADOLESCENT LIFE CHOICES
Entity Type:Organization
Organization Name:ADOLESCENT LIFE CHOICES
Other - Org Name:VISION QUEST ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SEELY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:435-867-4445
Mailing Address - Street 1:PO BOX 2949
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-2949
Mailing Address - Country:US
Mailing Address - Phone:435-867-4445
Mailing Address - Fax:435-867-4449
Practice Address - Street 1:467 N. 300 W.
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721
Practice Address - Country:US
Practice Address - Phone:435-867-4445
Practice Address - Fax:435-867-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children