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General NPI Number Information
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NPI Number | 1457585754
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Entity Type | Organization
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Legal Business Name | UINTA ACADEMY LC
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Dates
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Enumeration Date | 05/14/2009
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Last Update Date | 04/05/2010
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Provider Practice Location Address
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Address Line | 3746 SO. 4800 W.
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City | WELLSVILLE
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State | UT
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Zip | 84339
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Country | US
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Telephone | 435-245-2600
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Fax | 435-245-2605
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Provider Business Mailing Address
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Address Line | PO BOX 387
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City | WELLSVILLE
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State | UT
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Zip | 84339
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Country | US
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Telephone | 435-245-2600
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Fax | 435-245-2605
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ROBERT JEFFREY SIMPSON
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Credential | M.S., L.C.S.W.
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Telephone | 435-245-2600
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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 | 14237
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License Number State | UT
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