Provider Demographics
NPI:1881284453
Name:SEAGLASS HEALTH,LLC
Entity type:Organization
Organization Name:SEAGLASS HEALTH,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:801-928-0474
Mailing Address - Street 1:9035 EAST 1300 SOUTH
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094
Mailing Address - Country:US
Mailing Address - Phone:382-281-2221
Mailing Address - Fax:801-999-4161
Practice Address - Street 1:9035 EAST 1300 SOUTH
Practice Address - Street 2:SUITE 210
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094
Practice Address - Country:US
Practice Address - Phone:382-281-2221
Practice Address - Fax:801-999-4161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE824409479OtherSUBSTANCE ABUSE AND MENTAL HEALTH