Healthcare Provider Details

I. General information

NPI: 1255751558
Provider Name (Legal Business Name): OLYMPUS ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E 2700 S
HURRICANE UT
84737-4000
US

IV. Provider business mailing address

1500 E 2700 S
HURRICANE UT
84737-4000
US

V. Phone/Fax

Practice location:
  • Phone: 435-229-4889
  • Fax: 801-386-5482
Mailing address:
  • Phone: 435-229-4889
  • Fax: 801-386-5482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number8066
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number8067
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number8067
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number8067
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number6600
License Number StateUT
# 6
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number6600
License Number StateUT
# 7
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number8066
License Number StateUT
# 8
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number8066
License Number StateUT
# 9
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number8067
License Number StateUT
# 10
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number6600
License Number StateUT
# 11
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number6600
License Number StateUT

VIII. Authorized Official

Name: MR. JOSEPH AHQUIN SR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 435-229-4889