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NPI Code Detail

MEDICARE: STILLWATER ACADEMY

MEDICARE: STILLWATER ACADEMY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1323P00000XPsychiatric Residential Treatment Facility3732UT

General Provider Information

NPI Number : 1780004192
Entity Type Code : Organization
Provider Name (Legal Business Name) : STILLWATER ACADEMY
Provider Business Mailing Address
First Line : 11175 S REDWOOD RD
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095
Country : US
Telephone Number : 801-484-9911
Fax Number : 801-676-4150
Provider Business Practice Location Address
First Line : 11175 S REDWOOD RD
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-8208
Country : US
Telephone Number : 801-484-9911
Fax Number : 801-676-4150
Authorized Official
Title or Position : OFFICE MANAGER
Name : JAMIE CALDWELL
Credential :
Telephone Number : 801-484-9911
Provider Enumeration Date : 04/24/2014
Last Update Date : 09/11/2025

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