Provider Demographics
NPI:1952569352
Name:SECOND NATURE ENTRADA
Entity Type:Organization
Organization Name:SECOND NATURE ENTRADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-766-6604
Mailing Address - Street 1:2711 SANTA CLARA DR STE 400
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5480
Mailing Address - Country:US
Mailing Address - Phone:435-674-9310
Mailing Address - Fax:
Practice Address - Street 1:2711 SANTA CLARA DR STE 400
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:UT
Practice Address - Zip Code:84765-5480
Practice Address - Country:US
Practice Address - Phone:435-674-9310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT17943322D00000X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility