Provider Demographics
NPI:1902288376
Name:JAMES MASON CENTERS FOR RECOVERY
Entity Type:Organization
Organization Name:JAMES MASON CENTERS FOR RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-652-4567
Mailing Address - Street 1:986 W ATHERTON DR STE 270
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-6887
Mailing Address - Country:US
Mailing Address - Phone:801-693-1192
Mailing Address - Fax:
Practice Address - Street 1:986 W ATHERTON DR STE 270
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123-6887
Practice Address - Country:US
Practice Address - Phone:801-693-1192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13725261QM0855X
UT14684261QM0855X
UT18622261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder