Healthcare Provider Details

I. General information

NPI: 1366879793
Provider Name (Legal Business Name): SUNDANCE CANYON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 N 775 E
AMERICAN FORK UT
84003-2068
US

IV. Provider business mailing address

1766 LITTLE SWEDEN RD
DANIEL UT
84032-3505
US

V. Phone/Fax

Practice location:
  • Phone: 801-473-6606
  • Fax: 801-763-5758
Mailing address:
  • Phone: 435-671-4444
  • Fax: 435-503-8781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number3021
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number3021
License Number StateUT

VIII. Authorized Official

Name: SHERI HOOPER
Title or Position: FINANCIAL DIRECTOR
Credential:
Phone: 801-473-6606