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General NPI Number Information
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NPI Number | 1649380593
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Entity Type | Organization
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Legal Business Name | KIDS BEHAVIORAL HEALTH OF UTAH, INC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 03/30/2011
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Provider Practice Location Address
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Address Line | 5899 RIVENDELL DR
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City | WEST JORDAN
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State | UT
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Zip | 84088-5700
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Country | US
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Telephone | 801-561-3377
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Fax | 801-569-3274
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Provider Business Mailing Address
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Address Line | 5899 RIVENDELL DR
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City | WEST JORDAN
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State | UT
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Zip | 84088-5700
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Country | US
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Telephone | 801-561-3377
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Fax | 801-569-3274
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Authorized Official
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Title or Position | SRVPCFO
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Name | STEVE FILTON
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Credential |
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Telephone | 610-738-3300
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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 | 11944
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 11944
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License Number State | UT
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