Bryant Davis
Individual provider Active NPI Substance Abuse Rehabilitation Facility · Moroni, UT
NPI 1932460102 · NPPES record last updated Jun 5, 2012
Key facts
- NPI
- 1932460102
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Substance Abuse Rehabilitation Facility 324500000X
- License
- 272503815 (UT)
- Practice address
- 21360 North 1450 East
Moroni, UT 84646 - Phone
- (435) 445-5200
- NPI assigned
- Jun 5, 2012
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Abuse Rehabilitation Facility | 324500000X | 272503815 | UT | Yes |
Addresses
Primary practice location
21360 North 1450 East
Moroni, UT 84646
Mailing address
P.O. Box 461
21360 North 1450 East
Moroni, UT 84646
Phone (435) 445-5200
Other providers in Moroni, UT
- Compass Academy Transitional Services LLC
- Lorrie A. Cox
- Katie Cranford
- Kelly Cruz
- Daniel Dalene
- Rocky Dettamanti
- Adam Brent Dyches I
- Emanate Light Nonprofit
- Erick Espinoza
- Spencer Finlinson
All providers in Moroni, 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 Jun 5, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.