Provider Demographics
NPI:1760862288
Name:RICHFIELD BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:RICHFIELD BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARRON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-502-5408
Mailing Address - Street 1:635 N MAIN ST UNIT 669
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1895
Mailing Address - Country:US
Mailing Address - Phone:435-896-5327
Mailing Address - Fax:
Practice Address - Street 1:635 N MAIN ST UNIT 669
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1895
Practice Address - Country:US
Practice Address - Phone:435-896-5327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5040251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health