Provider Demographics
NPI:1235793290
Name:MOUNTAIN VALLEY RECOVERY LLC
Entity Type:Organization
Organization Name:MOUNTAIN VALLEY RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-253-0656
Mailing Address - Street 1:PO BOX 360252
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84636-0252
Mailing Address - Country:US
Mailing Address - Phone:435-253-0656
Mailing Address - Fax:
Practice Address - Street 1:9431 N 400 W
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:UT
Practice Address - Zip Code:84636
Practice Address - Country:US
Practice Address - Phone:435-253-0656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility