Provider Demographics
NPI:1235793290
Name:MOUNTAIN VALLEY RECOVERY LLC
Entity type:Organization
Organization Name:MOUNTAIN VALLEY RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:NIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-406-4093
Mailing Address - Street 1:275 W 100 S
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:UT
Mailing Address - Zip Code:84624-9238
Mailing Address - Country:US
Mailing Address - Phone:435-406-4093
Mailing Address - Fax:
Practice Address - Street 1:6910 N COWBOY LANE
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:UT
Practice Address - Zip Code:84636
Practice Address - Country:US
Practice Address - Phone:435-253-0656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility