Provider Demographics
NPI:1710204441
Name:ILLUME CENTER, INC
Entity Type:Organization
Organization Name:ILLUME CENTER, INC
Other - Org Name:ASCEND RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-216-4800
Mailing Address - Street 1:6280 W 9600 N
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9234
Mailing Address - Country:US
Mailing Address - Phone:801-216-4800
Mailing Address - Fax:
Practice Address - Street 1:6595 N 6000 W
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-4720
Practice Address - Country:US
Practice Address - Phone:801-216-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X
UT16410324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health