Organization
UNIVERSAL HEALTHSERVICES INC.
Active
Other names
Provo Canyon School
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMY COTTLE PHD (CEO)
(801) 229-1036
Entity
Organization
Contact information
Practice address
1350 E 750 N, NORTH OREM MEDICAID, OREM, UT 84097-4345
(801) 227-2100
Mailing address
1350 E 750 N, NORTH OREM MEDICAID, OREM, UT 84097-4345
(801) 227-2100
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
126677-3902
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609843523
—
UT
Enumeration date
08/27/2010
Last updated
08/27/2010
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