Provider Demographics
NPI:1871893115
Name:FERRONE, NICHOLAS CHRISTIAN (LSAC)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:CHRISTIAN
Last Name:FERRONE
Suffix:
Gender:M
Credentials:LSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 W 700 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104-1407
Mailing Address - Country:US
Mailing Address - Phone:801-946-1612
Mailing Address - Fax:801-359-8510
Practice Address - Street 1:411 GRANT ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-2725
Practice Address - Country:US
Practice Address - Phone:801-359-8862
Practice Address - Fax:801-359-8510
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility