SPLIT MOUNTAIN YOUTH CENTER (NPI# 1588272934) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588272934 |
| Entity Type | Organization |
| Organization Name | SPLIT MOUNTAIN YOUTH CENTER |
| Practice Address |
830 E Main St Vernal UT 84078-2708 |
| Practice Telephone | 4357892045 |
| Practice Fax Number | 4357892245 |
| Mailing Telephone | 4357892045 |
| Mailing Fax Number | 4357892245 |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2020-07-21 |
| Authorized Official Name | LAUREN MAYES (OFFICE MANAGER) |
| Authorized Official Telephone | 4357892045 |
| Is Organization Subpart | Y |
| Parent Organization Name | STATE OF UTAH |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| Street Address |
830 E MAIN ST |
| City | VERNAL |
| State | UT |
| Zip Code | 84078-2708 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205479748 | Wade Oliver Moulton | Pharmacist | 1080 W Hwy 40, Vernal, UT 84078 | 2019-10-28 |
| 1841610383 | Allegiance Addiction Recovery Center | Substance Abuse Rehabilitation Facility | 4430 N Little Valley Road, Vernal, UT 84078 | 2014-04-23 |
| 1689008773 | Ashley Valley Physician Practice, LLC | Occupational Therapist | 1680 W Highway 40 Ste 202, Vernal, UT 84078 | 2013-08-26 |
| 1528371796 | Terry L Smith | Counselor | 1140 W 500 S #9, Vernal, UT 84078 | 2010-07-16 |
| 1619280880 | Cicile M Rios | Counselor | 1140 W 800 S #9, Vernal, UT 84078 | 2010-07-16 |
| 1265754840 | Marjorie Elaine Gardner | Licensed Practical Nurse | 133 S 500 East, Vernal, UT 84078 | 2010-02-23 |
| 1528205853 | Robert Kirkham Jolley | Dentist | 40 West 100 North, Vernal, UT 84078 | 2009-01-08 |
| 1740482025 | Ashley Valley Physician Practice, LLC | Family Medicine | 175 N. 100 W., Suite 202, Vernal, UT 84078 | 2007-05-31 |
| 1265646459 | Ashley Valley Medical Center | Pharmacy | 151 W. 200 N., Vernal, UT 84078 | 2007-05-09 |
| 1629122692 | Brian Prentice Callahan | Dentist | 779 West Us Highway 40, Vernal, UT 84078 | 2007-01-23 |
| Find all providers in zip 84078 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073127866 | Alyssa Lauren Henderson | Case Manager/Care Coordinator | 1140 W 500 S Ste 9, Vernal, UT 84078-2912 | 2020-08-31 |
| 1700490596 | Rafe Dudley | Case Manager/Care Coordinator | 1140 W 500 S Ste 9, Vernal, UT 84078-2912 | 2020-08-31 |
| 1215580063 | Aaron Scott Wickel | Case Manager/Care Coordinator | 1140 W 500 S Ste 9, Vernal, UT 84078-2912 | 2019-07-22 |
| 1770050817 | Adrianna Troy Potts | Case Manager/Care Coordinator | 1140 W 500 S Ste 9, Vernal, UT 84078-2912 | 2018-10-26 |
| 1306375902 | Ryan Miller | Case Manager/Care Coordinator | 1140 W 500 S Ste 9, Vernal, UT 84078-2912 | 2017-06-07 |
| 1063963502 | Melissa Allen | Case Manager/Care Coordinator | 1140 W 500 S Ste 9, Vernal, UT 84078-2912 | 2016-10-19 |
| 1144686270 | Hale-lani Maile | Case Manager/Care Coordinator | 1140 W 500 S Ste 9, Vernal, UT 84078-2912 | 2016-01-05 |
| 1225429103 | Stephanie Lee Odriscoll | Case Manager/Care Coordinator | 1140 W 500 S, Vernal, UT 84078-2914 | 2015-02-12 |
| 1649671009 | Sandra Richins | Case Manager/Care Coordinator | 1140 W 500 S Ste 9, Vernal, UT 84078-2912 | 2014-09-04 |
| 1134548449 | Kelly Bingham | Case Manager/Care Coordinator | 133 S 500 E, Vernal, UT 84078-2728 | 2014-04-15 |
| Find all providers in VERNAL | ||||
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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.