Provider Demographics
NPI:1265184923
Name:VOYAGE RTC BLLC
Entity type:Organization
Organization Name:VOYAGE RTC BLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:MERLIN
Authorized Official - Last Name:BOHNE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:801-820-0158
Mailing Address - Street 1:5545 S 1225 E
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4522
Mailing Address - Country:US
Mailing Address - Phone:801-820-0158
Mailing Address - Fax:
Practice Address - Street 1:5545 S 1225 E
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4522
Practice Address - Country:US
Practice Address - Phone:801-820-0158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children