Provider Demographics
NPI:1558869255
Name:AWARENESS AND RECOVERY CENTER
Entity Type:Organization
Organization Name:AWARENESS AND RECOVERY CENTER
Other - Org Name:AWARENESS AND RECOVERY CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DEWEY
Authorized Official - Last Name:CAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:385-232-6482
Mailing Address - Street 1:406 E 300 S
Mailing Address - Street 2:127
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111
Mailing Address - Country:US
Mailing Address - Phone:385-232-6482
Mailing Address - Fax:
Practice Address - Street 1:2180 E 4500 S STE 210
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4029
Practice Address - Country:US
Practice Address - Phone:385-232-6482
Practice Address - Fax:385-232-6482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7095872-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty