Healthcare Provider Details

I. General information

NPI: 1528223195
Provider Name (Legal Business Name): TELOS RESIDENTIAL TREATMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 W CENTER ST
OREM UT
84057-5202
US

IV. Provider business mailing address

PO BOX 537
OREM UT
84059-0537
US

V. Phone/Fax

Practice location:
  • Phone: 801-426-8800
  • Fax:
Mailing address:
  • Phone: 801-426-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number12164
License Number StateUT

VIII. Authorized Official

Name: ANTHONY MOSIER
Title or Position: COO
Credential: LMFT
Phone: 801-380-8830