Provider Demographics
NPI:1710345749
Name:JURACAN CENTER LLC
Entity Type:Organization
Organization Name:JURACAN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:
Authorized Official - Last Name:JURACAN
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:801-310-3091
Mailing Address - Street 1:451 E 1000 S STE B
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3735
Mailing Address - Country:US
Mailing Address - Phone:801-310-3091
Mailing Address - Fax:
Practice Address - Street 1:451 E 1000 S STE B
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3735
Practice Address - Country:US
Practice Address - Phone:801-310-3091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2391843-6004251S00000X
UT8155586-6004251S00000X
UT8937085-6009251S00000X
UT208519-6004251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health