Organization
MAKANA LEADERSHIP ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHARON K SPERRY-CLEGG MA (COMPLIANCE DIRECTOR)
(801) 859-3505
Entity
Organization
Contact information
Practice address
4270 W 5625 N, ROOSEVELT, UT 84066-4824
(435) 353-4498
(435) 353-4898
Mailing address
4270 W 5625 N, ROOSEVELT, UT 84066-4824
(435) 353-4498
(435) 353-4898
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
174200000X
Meals Provider
—
—
177F00000X
Lodging Provider
—
—
251B00000X
Case Management Agency
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
310500000X
Mental Illness Intermediate Care Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
06/11/2020
Last updated
06/11/2020
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