Provider Demographics
NPI:1124234448
Name:METRO TREATMENT OF UTAH LP
Entity type:Organization
Organization Name:METRO TREATMENT OF UTAH LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-351-7080
Mailing Address - Street 1:2500 MAITLAND CENTER PARKWAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4174
Mailing Address - Country:US
Mailing Address - Phone:407-351-7080
Mailing Address - Fax:407-351-6930
Practice Address - Street 1:763 W 700 S STE B
Practice Address - Street 2:
Practice Address - City:WOODS CROSS
Practice Address - State:UT
Practice Address - Zip Code:84087-1438
Practice Address - Country:US
Practice Address - Phone:801-292-2318
Practice Address - Fax:801-292-2578
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METRO TREATMENT OF UT, LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-15
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12047251S00000X
UT4970056-17043336C0002X
261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No251S00000XAgenciesCommunity/Behavioral Health
No3336C0002XSuppliersPharmacyClinic Pharmacy