Organization
AWAKENING BEHAVIORAL HEALTH, LLC
Active
Parent organization
AWAKENING BEHAVIORAL HEALTH, 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
9160 S 300 W STE 3, SANDY, UT 84070-2656
(801) 545-0406
Mailing address
2973 W 13800 S, BLUFFDALE, UT 84065
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
37088
UT
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
37087
UT
261QR0800X
Recovery Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54650
STATE OF UTAH HUMAN SERVICES
UT
Enumeration date
12/26/2016
Last updated
11/27/2023
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