Provider Demographics
NPI:1427486653
Name:DESERT SOLACE
Entity type:Organization
Organization Name:DESERT SOLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEAZARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-668-6000
Mailing Address - Street 1:1239 W 4200 N
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5982
Mailing Address - Country:US
Mailing Address - Phone:435-703-3588
Mailing Address - Fax:888-696-5589
Practice Address - Street 1:1239 W 4200 N
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5982
Practice Address - Country:US
Practice Address - Phone:435-703-3588
Practice Address - Fax:888-696-5589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-25
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility