Provider Demographics
NPI:1922478056
Name:CLEAR RECOVERY OF CACHE VALLEY
Entity Type:Organization
Organization Name:CLEAR RECOVERY OF CACHE VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HYMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-258-8983
Mailing Address - Street 1:PO BOX 476
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-0476
Mailing Address - Country:US
Mailing Address - Phone:435-753-0253
Mailing Address - Fax:435-753-0106
Practice Address - Street 1:277 N SPRING CREEK PKWY
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9775
Practice Address - Country:US
Practice Address - Phone:435-753-0253
Practice Address - Fax:435-753-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT15425251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health