CIRQUE LODGE INC


Address: 3114 E Ida's Road, Sundance, UT 84604
Phone: 8012229200

CIRQUE LODGE INC (NPI# 1437692241) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1437692241
Entity Type Organization
Organization Name CIRQUE LODGE INC
Practice Address 3114 E Ida's Road
Sundance
UT 84604
Mailing Address Rr 3 Box A10
Sundance
UT 84604-8901
Practice Telephone 8012229200
Practice Fax Number 8012220112
Mailing Telephone 8012229200
Mailing Fax Number 8012220112
Enumeration Date 2016-11-28
Last Update Date 2016-11-28
Authorized Official Name GARY FISHER (EXECUTIVE DIRECTOR)
Authorized Official Telephone 8012229200
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 324500000X Substance Abuse Rehabilitation Facility 28275 UT Residential Treatment Facilities

Office Location

Street Address 3114 E IDA'S ROAD
City SUNDANCE
State UT
Zip Code 84604

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Taxonomy Information

Taxonomy Code 324500000X
Grouping Residential Treatment Facilities
Classification Substance Abuse Rehabilitation Facility

Taxonomy Definition

A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.
Notes: [7/1/2003: modified title, modified definition]

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Competitor

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City SUNDANCE
Zip Code 84604

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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