CROSS CREEK MANOR, LLC (NPI# 1356476873) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356476873 |
| Entity Type | Organization |
| Organization Name | CROSS CREEK MANOR, LLC |
| Other Organization Name | CROSS CREEK MANOR |
| Practice Address |
150 N State St La Verkin UT 84745-5503 |
| Mailing Address |
50 S State St La Verkin UT 84745-5400 |
| Practice Telephone | 4356352390 |
| Practice Fax Number | 4356352778 |
| Mailing Telephone | 4356352390 |
| Mailing Fax Number | 4356352778 |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. KARR FARNSWORTH (DIRECTOR) |
| Authorized Official Telephone | 4356356003 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | 12143 | UT | Residential Treatment Facilities |
| X | 323P00000X | Psychiatric Residential Treatment Facility | 12145 | UT | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| CROSS CREEK MANOR | Other Name - Individual/Organization |
| Street Address |
150 N STATE ST |
| City | LA VERKIN |
| State | UT |
| Zip Code | 84745-5503 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750634382 | Youth Foundations | Residential Treatment Facility, Emotionally Disturbed Children | 150 N State St, La Verkin, UT 84745-5503 | 2012-10-19 |
| 1083730725 | Kenneth Lee Seely | Psychologist | 150 N State St, La Verkin, UT 84745-5503 | 2007-03-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841766201 | Taylor Lyman Beatty | Nurse Practitioner | 819 N 370 W, La Verkin, UT 84745-5063 | 2018-10-23 |
| 1457450843 | Clifford E Holt | Pharmacist | 495 N State St, La Verkin, UT 84745-5124 | 2006-09-21 |
| 1558605816 | Davis/burkett Food Corp | Pharmacy | 495 N State St, La Verkin, UT 84745-5124 | 2012-11-26 |
| 1366573461 | Market Pharmacy | Pharmacy | 495 N State St, La Verkin, UT 84745-5124 | 2007-03-08 |
| 1326217704 | Timandra E. Fawson | Marriage & Family Therapist | 173 N 250 W, La Verkin, UT 84745-5236 | 2008-02-29 |
| 1780900464 | Cross Creek Manor | Residential Treatment Facility, Emotionally Disturbed Children | 50 S State St, La Verkin, UT 84745-5443 | 2010-04-20 |
| 1225648199 | Soulegria LLC | Clinic/Center | 50 S State St, La Verkin, UT 84745-5443 | 2020-08-05 |
| 1235625385 | Carevoy LLC | Day Training, Developmentally Disabled Services | 50 S State St, La Verkin, UT 84745-5443 | 2018-07-02 |
| 1114457843 | Carevoy LLC | Marriage & Family Therapist | 50 S State St, La Verkin, UT 84745-5443 | 2017-06-15 |
| 1639513278 | Courtney Taylor Lyman | Counselor | 50 S State St, La Verkin, UT 84745-5443 | 2013-04-25 |
| Find all providers in zip 84745 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780900464 | Cross Creek Manor | Residential Treatment Facility, Emotionally Disturbed Children | 50 S State St, La Verkin, UT 84745-5443 | 2010-04-20 |
| 1750634382 | Youth Foundations | Residential Treatment Facility, Emotionally Disturbed Children | 150 N State St, La Verkin, UT 84745-5503 | 2012-10-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063013167 | Elevated Youth Services | Residential Treatment Facility, Emotionally Disturbed Children | 10928 S Eureka Dune Dr, South Jordan, UT 84009-4173 | 2020-11-04 |
| 1003430133 | Cascade Academy | Residential Treatment Facility, Emotionally Disturbed Children | 430 W 200 N, Midway, UT 84049 | 2020-06-04 |
| 1659900835 | Change Academy At Lake of The Ozarks | Residential Treatment Facility, Emotionally Disturbed Children | 266 South Left Fork Hobble Creek Canyon Road, Springville, UT 84663 | 2020-04-08 |
| 1083107320 | Red Circle Lodge, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 930 N Memorial St, Hildale, UT 84784 | 2018-06-12 |
| 1023560679 | Meridian Mentoring | Residential Treatment Facility, Emotionally Disturbed Children | 635 South Main St., Orangeville, UT 84537 | 2016-10-31 |
| 1720456981 | Gateway Academy, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 941 E Cattail Dr, Draper, UT 84020-8583 | 2015-09-04 |
| 1033592290 | Keystone Family Support, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 2558 Valley View Dr, Layton, UT 84040-7654 | 2015-07-07 |
| 1285033977 | Utah Family Care LLC | Residential Treatment Facility, Emotionally Disturbed Children | 3575 S 3200 W Apt 6c, West Valley City, UT 84119-3571 | 2014-08-19 |
| 1982011649 | Teen Discovery Home | Residential Treatment Facility, Emotionally Disturbed Children | 10 East 100 South, Gunnison, UT 84634 | 2014-07-15 |
| 1245663947 | South Pointe Youth | Residential Treatment Facility, Emotionally Disturbed Children | 1500 South 580 West, Manti, UT 84642-0314 | 2013-08-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.