# MAPLE LAKE ACADEMY FOR BOYS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568900116
- **Authorized official:** MARGO L VANE (OFFICE MANAGER)
- **Authorized official phone:** (801) 798-7700

## Contact information

- **Practice address:** 6612 S 3200 W, BENJAMIN, UT 84660-4123
- **Practice address phone:** (801) 798-7700
- **Mailing address:** 6612 S 3200 W, BENJAMIN, UT 84660-4123
- **Mailing address phone:** (801) 798-7700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 323P00000X | Psychiatric Residential Treatment Facility | 18290 | UT | Yes |

## Other

- **Enumeration date:** 02/03/2017
- **Last updated:** 02/03/2017