Provider Demographics
NPI:1710376199
Name:DMDR, LLC
Entity type:Organization
Organization Name:DMDR, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:SUDC, SAP
Authorized Official - Phone:801-784-9455
Mailing Address - Street 1:145 S 200 E
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-2047
Mailing Address - Country:US
Mailing Address - Phone:801-784-9455
Mailing Address - Fax:888-876-2112
Practice Address - Street 1:145 S 200 E
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-2047
Practice Address - Country:US
Practice Address - Phone:801-784-9455
Practice Address - Fax:888-876-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility