Healthcare Provider Details

I. General information

NPI: 1518067578
Provider Name (Legal Business Name): CINNAMON HILLS YOUTH CRISIS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 E SAINT GEORGE BLVD
SAINT GEORGE UT
84770-3034
US

IV. Provider business mailing address

770 E SAINT GEORGE BLVD
SAINT GEORGE UT
84770-3034
US

V. Phone/Fax

Practice location:
  • Phone: 435-674-0984
  • Fax:
Mailing address:
  • Phone: 435-674-0984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number11761
License Number StateUT

VIII. Authorized Official

Name: BUFF L WILLIAMS
Title or Position: PRESIDENT
Credential:
Phone: 435-674-0984