Provider Demographics
NPI:1346915428
Name:ACCIDENT RECOVERY CLINIC, LLC
Entity Type:Organization
Organization Name:ACCIDENT RECOVERY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAWE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:801-318-8869
Mailing Address - Street 1:841 W 1100 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-9647
Mailing Address - Country:US
Mailing Address - Phone:801-318-8869
Mailing Address - Fax:
Practice Address - Street 1:12056 W FOXHAVEN ST
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669-5953
Practice Address - Country:US
Practice Address - Phone:801-318-8869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care