Provider Demographics
NPI:1245680206
Name:PARADIGM RECOVERY CENTER
Entity type:Organization
Organization Name:PARADIGM RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-586-1040
Mailing Address - Street 1:1192 E DRAPER PKWY # 466
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9356
Mailing Address - Country:US
Mailing Address - Phone:877-586-1040
Mailing Address - Fax:877-411-9114
Practice Address - Street 1:12997 S SUMMERHARVEST DR
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9355
Practice Address - Country:US
Practice Address - Phone:877-586-1040
Practice Address - Fax:877-411-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT20408324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility