Basic Information
| Provider Information | |||||||||
| NPI: | 1912064650 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY TREATMENT ALTERNATIVES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4444 S 700 E | ||||||||
| Address2: | 203 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841073075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012684887 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4444 S 700 E | ||||||||
| Address2: | 203 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841073075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012684887 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | EREKSON | ||||||||
| AuthorizedOfficialFirstName: | DUSTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8012684887 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320900000X | Y | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
No ID Information.