Provider Demographics
NPI:1750052924
Name:MOUNTAIN PEAKS RECOVERY FOUNDATION
Entity Type:Organization
Organization Name:MOUNTAIN PEAKS RECOVERY FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KROEBER
Authorized Official - Suffix:
Authorized Official - Credentials:SUDC
Authorized Official - Phone:385-312-8400
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-0309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:383 N STATE ST STE 201
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4781
Practice Address - Country:US
Practice Address - Phone:385-312-8400
Practice Address - Fax:801-734-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder