Provider Demographics
NPI:1730778234
Name:SOLASTA HEALING CENTER
Entity type:Organization
Organization Name:SOLASTA HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUDSANDOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-250-7478
Mailing Address - Street 1:10082 N OAK RD W
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84062-9007
Mailing Address - Country:US
Mailing Address - Phone:385-250-7478
Mailing Address - Fax:
Practice Address - Street 1:1404 W STATE RD STE 209
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-5041
Practice Address - Country:US
Practice Address - Phone:385-250-7478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty