# MAPLE LAKE ACADEMY

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

## Provider details

- **NPI number:** 1932467495
- **Authorized official:** MARGO L VANE (OFFICE MANAGER)
- **Authorized official phone:** (801) 798-7700

## Contact information

- **Practice address:** 6155 S 2400 W, SPANISH FORK, UT 84660-4606
- **Practice address phone:** (801) 798-7700
- **Mailing address:** 6155 S 2400 W, SPANISH FORK, UT 84660-4606
- **Mailing address phone:** (801) 798-7700

## Taxonomy

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

## Other

- **Enumeration date:** 05/02/2012
- **Last updated:** 05/02/2012