Provider Demographics
NPI:1336695402
Name:SPIRIT MOUNTAIN RECOVERY, INC.
Entity Type:Organization
Organization Name:SPIRIT MOUNTAIN RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FARNI
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MBA, CPA
Authorized Official - Phone:612-805-5231
Mailing Address - Street 1:3181 E 3350 N
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84310-9712
Mailing Address - Country:US
Mailing Address - Phone:801-336-0658
Mailing Address - Fax:
Practice Address - Street 1:3181 E 3350 N
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:UT
Practice Address - Zip Code:84310-9712
Practice Address - Country:US
Practice Address - Phone:801-336-0658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT31485324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility