Provider Demographics
NPI:1063692804
Name:SECOND NATURE ENTRADA LLC
Entity type:Organization
Organization Name:SECOND NATURE ENTRADA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEIZER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:435-674-9310
Mailing Address - Street 1:2711 SANTA CLARA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5466
Mailing Address - Country:US
Mailing Address - Phone:435-674-9310
Mailing Address - Fax:435-674-9309
Practice Address - Street 1:2711 SANTA CLARA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA CLARA
Practice Address - State:UT
Practice Address - Zip Code:84765-5466
Practice Address - Country:US
Practice Address - Phone:435-674-9310
Practice Address - Fax:435-674-9309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12776261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health