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NPI 1639927684 · Mental Illness Community Based Residential Treatment Facility · Salt Lake City, UT
Provider details
- NPI number
- 1639927684
- Entity type
- Organization
- Primary specialty
- Mental Illness Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Melissa Radcliffe, Founder(801) 792-5557
Specialties & taxonomies
Residential Treatment Facilities
- Medical Physician Assistant363AM0700X
Physician Assistants & Advanced Practice Nursing Providers
- Family Nurse Practitioner363LF0000X
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
- Mental Health Counselor101YM0800X
Behavioral Health & Social Service Providers
Behavioral Health & Social Service Providers
Practice location
150 S 600 E Ste 3a
Salt Lake City, UT 84102-1961
Phone: (801) 792-5557
Approximate (ZIP-level) locationGet directions
Mailing address
150 S 600 E Ste 3a
Salt Lake City, UT 84102-1961
Registry dates
- Enumerated
- 2024-05-07
- Last updated
- 2024-05-07
- Certified
- 2024-05-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.