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General NPI Number Information
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NPI Number | 1184089013
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Entity Type | Organization
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Legal Business Name | UT-TEX, INC
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Dates
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Enumeration Date | 12/18/2015
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Last Update Date | 12/18/2015
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Provider Practice Location Address
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Address Line | 3149 E 9800 S
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City | SANDY
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State | UT
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Zip | 84092-4213
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Country | US
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Telephone | 385-237-3600
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Fax | 801-417-9607
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Provider Business Mailing Address
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Address Line | 1122 W SOUTH JORDAN PKWY SUITE B
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-5507
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Country | US
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Telephone | 801-446-6312
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Fax | 801-446-7746
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Authorized Official
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Title or Position | OWNER
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Name | H MATTHEW DIXON JR.
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Credential |
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Telephone | 801-446-6312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 18587
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License Number State | UT
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