Provider Demographics
NPI:1154794139
Name:CPF RECOVERY WAYS LAB
Entity type:Organization
Organization Name:CPF RECOVERY WAYS LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-293-6100
Mailing Address - Street 1:4848 S COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-4761
Mailing Address - Country:US
Mailing Address - Phone:801-293-6100
Mailing Address - Fax:801-266-2320
Practice Address - Street 1:4050 S HOWICK ST
Practice Address - Street 2:SUITE 11E
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-1448
Practice Address - Country:US
Practice Address - Phone:801-293-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT57094291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory