| One- Eighty Out Llc | |
|
2872 S Highland Dr S Salt Lake UT 84106-3147 | |
| (801) 485-8051 | |
| Not Available |
| Full Name | One- Eighty Out Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2872 S Highland Dr, S Salt Lake, Utah |
| Authorized Official Name and Position | Brittany Randall (OWNER) |
| Authorized Official Contact | 8016715990 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| One- Eighty Out Llc 10935 N Highway 38 Deweyville UT 84309-9737 Ph: (801) 671-5990 | One- Eighty Out Llc 2872 S Highland Dr S Salt Lake UT 84106-3147 Ph: (801) 485-8051 |
| NPI Number | 1114517943 |
|---|---|
| Provider Enumeration Date | 01/26/2021 |
| Last Update Date | 09/24/2021 |
| Certification Date | 09/24/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114517943 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |