Healthcare Provider Details

I. General information

NPI: 1689746794
Provider Name (Legal Business Name): UHS OF KOOTENAU RIVER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 08/14/2007

III. Provider practice location address

COUNTY ROAD 12 RUBY CREEK ROAD
NAPLES ID
83847-0230
US

IV. Provider business mailing address

1350 E 750 N CENTRAL BUSINESS OFFICE
OREM UT
84097-4345
US

V. Phone/Fax

Practice location:
  • Phone: 801-227-2000
  • Fax:
Mailing address:
  • Phone: 801-227-2000
  • Fax: 801-229-1043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number18251
License Number StateID

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: CFO SR VP
Credential:
Phone: 610-768-3300