419 Medical Squadron
Rehabilitation, Substance Use Disorder Unit in Hill Afb, UT. Organization (NPI-2).
NPI number1689691230
StatusActive
Last updated in NPPESJun 13, 2008
Details
- NPI
- 1689691230
- Entity type
- Organization (NPI-2)
- Legal business name
- 419 Medical Squadron
- Organization subpart
- No
- Enumeration date
- Jul 17, 2006
- Last updated
- Jun 13, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 276400000X | Rehabilitation, Substance Use Disorder Unit | 06477 | IA | Yes |
Practice location
7311 11th StHill Afb, UT 84056-5012
Phone 801-777-2622
Mailing address
3626 W 2000 NWest Point, UT 84015-7300
Phone 801-776-8767
Authorized official
Robert Atisme
Mental Health Therapist
8017772622
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