Provider Demographics
NPI:1598219149
Name:EQUINOX RTC, LLC
Entity type:Organization
Organization Name:EQUINOX RTC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:801-913-8795
Mailing Address - Street 1:530 UPPER FLAT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-8331
Mailing Address - Country:US
Mailing Address - Phone:828-484-9928
Mailing Address - Fax:
Practice Address - Street 1:2420 MIDDLE FORK RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-1032
Practice Address - Country:US
Practice Address - Phone:801-913-8795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility