Provider Demographics
NPI:1720430986
Name:NORTH WASATCH RECOVERY
Entity Type:Organization
Organization Name:NORTH WASATCH RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-599-0600
Mailing Address - Street 1:2740 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-3320
Mailing Address - Country:US
Mailing Address - Phone:801-599-0600
Mailing Address - Fax:
Practice Address - Street 1:2740 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-3320
Practice Address - Country:US
Practice Address - Phone:801-599-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility