Provider Demographics
NPI:1477008498
Name:HEALING SCIENCE RETREAT LLC
Entity Type:Organization
Organization Name:HEALING SCIENCE RETREAT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEYOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-630-2792
Mailing Address - Street 1:12231 S 1950 E
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9671
Mailing Address - Country:US
Mailing Address - Phone:385-630-2792
Mailing Address - Fax:
Practice Address - Street 1:12231 S 1950 E
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9671
Practice Address - Country:US
Practice Address - Phone:385-630-2792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTAPPLIED FOR324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility