NPIMap

Organization Active NPI

Acqua Recovery LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Midway, UT
National Provider Identifier
1932595899
Registry record updated Apr 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
13414 Issued in UT
Legal business name
ACQUA RECOVERY LLC
Practice address
100 N Johnson Mill Rd
Midway, UT 84049-6764
Phone
(954) 678-0078
NPI assigned
Apr 7, 2015
Last updated
Apr 7, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2015

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

Authorized official

Name
Mr. Clint Tolman
Title
Director
Phone
(954) 678-0078

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 13415 UT
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 13414 UT Primary
Substance Abuse Rehabilitation Facility 324500000X 10218 UT

Addresses

Primary practice location

100 N Johnson Mill Rd
Midway, UT 84049-6764

Mailing address

1031 S Douglas St
Salt Lake City, UT 84105-1505

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D2092398Acqua Recovery LLC100 N Johnson Mill Road, Midway, UT 84049Certificate of waiverMar 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Acqua Recovery LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1428364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428364800000",
    "number": "1932595899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1031 S DOUGLAS ST",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841051505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N JOHNSON MILL RD",
            "city": "MIDWAY",
            "state": "UT",
            "postal_code": "840496764",
            "telephone_number": "954-678-0078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACQUA RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-07",
        "last_updated": "2015-04-07",
        "status": "A",
        "authorized_official_last_name": "TOLMAN",
        "authorized_official_first_name": "CLINT",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "954-678-0078",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "UT",
            "license": "13415",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "UT",
            "license": "13414",
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "UT",
            "license": "10218",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midway, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.