Active Recovery, LLC
Organization Active NPI Substance Abuse Rehabilitation Facility · Centerville, UT
NPI 1104460666 · NPPES record last updated Oct 28, 2019
Key facts
- NPI
- 1104460666
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Abuse Rehabilitation Facility 324500000X
- Legal business name
- ACTIVE RECOVERY, LLC
- Practice address
- 25 S Main St # 212
Centerville, UT 84014-1840 - Phone
- (801) 663-6656
- NPI assigned
- Oct 28, 2019
- Organization subpart
- No
Authorized official
- Name
- Lance Hori, CPA
- Title
- Clinical Director
- Phone
- (801) 628-4944
Practitioners 3
-
Brandon Mark Flammer, D.O.
-
Douglas Hopper, LMFT
-
Emily Cook, DO
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200817002142 | UT | Part B Supplier - Clinic/Group Practice | 4082030416 |
Receives reassigned benefits from 2 practitioners Practice locations: Centerville, UT |
National Provider Directory
Locations
25 S Main St
Ste 212
Centerville, UT 84014
Phone (385) 394-9070
25 S Main St
Ste 202
Centerville, UT 84014
Phone (801) 663-6656
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Abuse Rehabilitation Facility | 324500000X | Yes |
Addresses
Primary practice location
25 S Main St # 212
Centerville, UT 84014-1840
Mailing address
25 S Main St # 212
Centerville, UT 84014-1840
Phone (801) 663-6656
Other providers in Centerville, UT
- Advanced Technology Spinal Center, Inc.
- Joshua Alldredge
- Rebecca Esther Allen
- Reagan E. K. Anderson
- David Elliot Anisman
All providers in Centerville, UT · Substance Abuse Rehabilitation Facility in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 28, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.