Provider Demographics
NPI:1609130418
Name:UTAH ADDICTION CENTERS
Entity Type:Organization
Organization Name:UTAH ADDICTION CENTERS
Other - Org Name:INNER-VENTION BEHAVIORAL HEALTH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARRON
Authorized Official - Middle Name:QUENTIN
Authorized Official - Last Name:BOBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-766-2233
Mailing Address - Street 1:2590 PRARIE VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005
Mailing Address - Country:US
Mailing Address - Phone:801-766-2233
Mailing Address - Fax:
Practice Address - Street 1:2590 PRARIE VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005
Practice Address - Country:US
Practice Address - Phone:801-766-2233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility