Organization
DDMS OF UTAH NO.2
Active
Other names
North Side Center
Organization subpart
No
Provider details
NPI number
Authorized official
MISTI ANN BUCK D.O./ADMINISTRATOR (DIRECTOR OF OPERATIONS)
(801) 763-9299
Entity
Organization
Contact information
Practice address
340 N 100 W, BOUNTIFUL, UT 84010-6054
(801) 292-6797
(801) 295-3660
Mailing address
119 S PACIFIC DR, 119, AMERICAN FORK, UT 84003-2196
(801) 763-9299
(801) 763-1121
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
2015-SHCF-344
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2015-SHCF-344
—
UT
Enumeration date
10/02/2015
Last updated
06/08/2023
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