Provider Demographics
NPI:1972930501
Name:SAINT ANTHONY'S TREATMENT HOUSE LLC
Entity Type:Organization
Organization Name:SAINT ANTHONY'S TREATMENT HOUSE LLC
Other - Org Name:THE UTAH HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALYCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JURGELA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:801-678-3317
Mailing Address - Street 1:1370 S WEST TEMPLE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-5218
Mailing Address - Country:US
Mailing Address - Phone:801-678-3317
Mailing Address - Fax:385-229-4324
Practice Address - Street 1:1370 S WEST TEMPLE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-5218
Practice Address - Country:US
Practice Address - Phone:801-678-3317
Practice Address - Fax:385-229-4324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT20825251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1477985516Medicaid