Provider Demographics
NPI:1174948079
Name:MAPLE MOUNTAIN RECOVERY
Entity type:Organization
Organization Name:MAPLE MOUNTAIN RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:801-602-8336
Mailing Address - Street 1:727 E 1100 S
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-5016
Mailing Address - Country:US
Mailing Address - Phone:801-489-9871
Mailing Address - Fax:801-489-9780
Practice Address - Street 1:727 E 1100 S
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:UT
Practice Address - Zip Code:84664-5016
Practice Address - Country:US
Practice Address - Phone:801-489-9871
Practice Address - Fax:801-489-9780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5709324500000X
UT5708324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility