National Provider Identifier Database

CIRQUE LODGE INC
Substance Abuse Disorder Rehabilitation Facility

A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.


Contact Information

CIRQUE LODGE INC
3114 E IDA'S ROAD
SUNDANCE, UT84604
Phone: 801-222-9200
Fax: 801-222-0112
Website:
Specialty Taxonomy Code
* Substance Abuse Disorder Rehabilitation Facility 324500000X

* Indicates primary specialty

NPI Profile & details for CIRQUE LODGE INC

NPI Number 1437692241
Legal business name
LBN
CIRQUE LODGE INC
Authorized official GARY FISHER - (EXECUTIVE DIRECTOR)
Entity Organization
Organization subpart No
Enumeration date 11/28/2016
Last updated 11/28/2016 - About 10 years ago
Sole proprietor1 Not specified
Identifiers
  • UT License #: 28275

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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