Provider Demographics
NPI:1760194559
Name:WASATCH CREST TREATMENT SERVICES
Entity Type:Organization
Organization Name:WASATCH CREST TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:949-554-3611
Mailing Address - Street 1:425 MOULTON LN
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3843
Mailing Address - Country:US
Mailing Address - Phone:801-935-1593
Mailing Address - Fax:
Practice Address - Street 1:241 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-6405
Practice Address - Country:US
Practice Address - Phone:800-385-3507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASATCH CREST RECOVERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder