Mystic Motion Inc

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

15350 Issued in UT

Legal business name

MYSTIC MOTION INC

Doing business as

Lighthouse Recovery Center

Practice address

7602 South Main Street
Midvale, UT 84047

Phone

(801) 631-7122

Fax

(877) 840-9122

NPI assigned

Jun 11, 2009

Last updated

Jun 11, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Bret Richard Hiner, LSAC,BRI-1

Title

President

Phone

(801) 631-7122

Specialties & licenses 1

Addresses

Other names 1

• Lighthouse Recovery Center Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244678400000",
    "number": "1386871853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7602 SOUTH MAIN STREET",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "84047",
            "telephone_number": "801-631-7122",
            "fax_number": "877-840-9122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7602 SOUTH MAIN STREET",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "84047",
            "telephone_number": "801-631-7122",
            "fax_number": "877-840-9122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC MOTION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-11",
        "last_updated": "2009-06-11",
        "status": "A",
        "authorized_official_last_name": "HINER",
        "authorized_official_first_name": "BRET",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-631-7122",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LSAC,BRI-1"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "UT",
            "license": "15350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lighthouse Recovery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Substance Abuse Rehabilitation Facility in Midvale, UT
• Providers in Midvale, UT by specialty
• Substance Abuse Rehabilitation Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.