Organization
AWAKENING BEHAVIORAL HEALTH, LLC
Active
Parent organization
AWAKENING BEHAVIORAL HEALTH, LLC
Other names
Renaissance Ranch Treatment Centers, Renaissance Ranch Bluffdale Men's Program, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
AWAKENING BEHAVIORAL HEALTH, LLC
Authorized official
KERRYLYNN BACA-PELPHREY (CCO, EXEC DIR PAYOR RELATIONS)
(801) 658-9646
Entity
Organization
Contact information
Practice address
2973 W 13800 S, BLUFFDALE, UT 84065-8202
(801) 545-0406
Mailing address
2973 W 13800 S, BLUFFDALE, UT 84065-8202
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
26066
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568909117
NPI FOR SPECIFIC FACILITY RENAISSANCE RANCH BLUFFDALE MEN'S PROGRAM, LLC
—
01
—
51983
STATE OF UTAH HUMAN SERVICES
UT
Enumeration date
12/20/2016
Last updated
03/30/2020
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