Organization
UHS PROVO CANYON INC
Active
Other names
Provo Canyon School
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE FILTON (CFO/ SR VP)
(610) 768-3300
Entity
Organization
Contact information
Practice address
4501 N UNIVERSITY AVE, PROVO, UT 84604-5504
(800) 848-9819
Mailing address
4501 N UNIVERSITY AVE, PROVO, UT 84604-5504
(800) 848-9819
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
11043
UT
323P00000X
Psychiatric Residential Treatment Facility
3699
UT
323P00000X
Psychiatric Residential Treatment Facility
3701
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000M0056
—
NM
05
—
131599140
—
UT
Enumeration date
03/01/2006
Last updated
12/03/2014
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