MYSTIC MOTION INC (NPI# 1386871853) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386871853 |
| Entity Type | Organization |
| Organization Name | MYSTIC MOTION INC |
| Other Organization Name | LIGHTHOUSE RECOVERY CENTER |
| Practice Address |
7602 South Main Street Midvale UT 84047 |
| Practice Telephone | 8016317122 |
| Practice Fax Number | 8778409122 |
| Mailing Telephone | 8016317122 |
| Mailing Fax Number | 8778409122 |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2009-06-11 |
| Authorized Official Name | MR. BRET RICHARD HINER (PRESIDENT) |
| Authorized Official Telephone | 8016317122 |
| Authorized Official Credential | LSAC,BRI-1 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 15350 | UT | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Lighthouse Recovery Center | Doing Business As Name - Organization |
| Street Address |
7602 SOUTH MAIN STREET |
| City | MIDVALE |
| State | UT |
| Zip Code | 84047 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649885096 | Wound Pros Utah | Durable Medical Equipment & Medical Supplies | 6975 Union Park Avenue, Suite 600, Cottonwood Heights, UT 84047 | 2020-09-12 |
| 1457965824 | Duy Danny Vo | Pharmacist | 7200 S State St, Midvale, UT 84047 | 2020-09-03 |
| 1619457314 | Tlcpo LLC | Counselor | 6975 Union Park Avenue Suite 600, Cottonwood Heights, UT 84047 | 2018-08-21 |
| 1700371606 | Heather Ivana Lawrence | Social Worker | 6856 700 E, Midvale, Ut 84047, Midvale,ut, UT 84047 | 2018-06-25 |
| 1285128942 | A&a Counseling | Counselor | 7602 S Main St, Midvale, UT 84047 | 2018-06-17 |
| 1396235339 | Hhalmid | Assisted Living Facility | 6968 S 700 E, Midvale, UT 84047 | 2018-05-15 |
| 1750879987 | Rosemarie Elaine Brinig | Counselor | 75 E. Ft. Union, C118, Midvale, UT 84047 | 2018-04-24 |
| 1861921140 | Olivia Devenport | Behavior Technician | 7434 S State Street, Midvale, UT 84047 | 2017-06-08 |
| 1376083071 | Marathon Health, LLC | Nurse Practitioner | 7259 South Bingham Junction, C/o Chg- Ut Health Center, Midvale, UT 84047 | 2017-02-28 |
| 1710436316 | Michael Naanes | Physical Therapist | 900 East 6900 South, Suite 100, Midvale, UT 84047 | 2016-09-25 |
| Find all providers in zip 84047 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse 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. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801138433 | Next Level Recovery LLC | Substance Abuse Rehabilitation Facility | 6771 S 900 E, Midvale, UT 84047-1436 | 2013-03-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063013886 | Brc Wellness LLC | Substance Abuse Rehabilitation Facility | 4911 S 900 E Ste B, Salt Lake City, UT 84117-5747 | 2020-11-06 |
| 1891307104 | Steps Recovery Center | Substance Abuse Rehabilitation Facility | 345 E 4500 S # 100-140, Murray, UT 84107-3991 | 2020-08-18 |
| 1104460666 | Active Recovery, LLC | Substance Abuse Rehabilitation Facility | 25 S Main St # 212, Centerville, UT 84014-1840 | 2019-10-28 |
| 1437709441 | Insight Recovery Cedar City, LLC | Substance Abuse Rehabilitation Facility | 1050 W Old Highway 91, Parowan, UT 84761-7725 | 2019-09-12 |
| 1316506470 | Evnsq, LLC | Substance Abuse Rehabilitation Facility | 5162 S Highland Dr, Holladay, UT 84117-7048 | 2019-06-11 |
| 1114584356 | Juniper Canyon Recovery Center for Women, LLC | Substance Abuse Rehabilitation Facility | 520 North Aspen Road, Loa, UT 84747-8474 | 2019-05-23 |
| 1750948030 | Liberty Addiction Recovery Centers LLC | Substance Abuse Rehabilitation Facility | 10458 N 6570 W, Highland, UT 84003-9311 | 2019-05-22 |
| 1235793290 | Mountain Valley Recovery LLC | Substance Abuse Rehabilitation Facility | 9431 N 400 W, Holden, UT 84636 | 2019-04-25 |
| 1346803525 | Brookstone Foundation | Substance Abuse Rehabilitation Facility | 198 N 100 E # 198n100e, St George, UT 84770-2831 | 2019-04-15 |
| 1639649684 | Sterling Recovery | Substance Abuse Rehabilitation Facility | 525 W 465 N Ste 130, Providence, UT 84332-5604 | 2018-12-03 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on MYSTIC MOTION INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.