# DDMS OF UTAH NO.2

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- **Entity:** Organization
- **Status:** Active
- **Other names:** West Side Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558730218
- **Authorized official:** MISTI ANN BUCK D.O./ADMINISTRATOR (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (801) 763-9299

## Contact information

- **Practice address:** 4028 S 4800 W, WEST VALLEY CITY, UT 84120-4537
- **Practice address phone:** (801) 968-8122
- **Practice address fax:** (801) 968-8135
- **Mailing address:** 4028 S 4800 W, WEST VALLEY CITY, UT 84120-4537
- **Mailing address phone:** (801) 968-8122
- **Mailing address fax:** (801) 968-8135

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 2015-SHCF-101 | UT | Yes |

## Other

- **Enumeration date:** 09/23/2015
- **Last updated:** 06/08/2023