UTAH ADDICTION CENTERS (NPI# 1629423280) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629423280 |
| Entity Type | Organization |
| Organization Name | UTAH ADDICTION CENTERS |
| Practice Address |
2590 E Prairie View Dr Eagle Mountain UT 84005-6096 |
| Practice Telephone | 8017662233 |
| Mailing Telephone | 8017662233 |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2016-05-02 |
| Authorized Official Name | JEREMY QUENTIN BOBERG (OWNER) |
| Authorized Official Telephone | 8016348938 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 324500000X | Substance Abuse Rehabilitation Facility | 21344 | UT | Residential Treatment Facilities |
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | 13999 | UT | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609130418 | Utah Addiction Centers | Substance Abuse Rehabilitation Facility | 2590 Prarie View Drive, Eagle Mountain, UT 84005 | 2012-06-26 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | UTAH ADDICTION CENTERS, LLC. | 2590 Prarie View Dr, Eagle Mountain, UT 84005-6096 |
| Street Address |
2590 E PRAIRIE VIEW DR |
| City | EAGLE MOUNTAIN |
| State | UT |
| Zip Code | 84005-6096 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942666870 | Jeremy Boberg | Counselor | 2590 E Prairie View Dr, Eagle Mountain, UT 84005-6096 | 2016-01-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922573856 | Eagle Mountain Children's Dentistry Pllc | Clinic/Center | 3435 Pony Express Parkway Ste. 130, Eagle Mountain, UT 84005 | 2018-10-08 |
| 1437650157 | Michael Hogue | Emergency Medical Technician, Basic | 2036 E Harkers Way, Eagle Mountain, UT 84005 | 2018-02-27 |
| 1376050682 | Bell Adult Healthcare and Wellness Pllc | Nurse Practitioner | 4719 E Silver Creek Way, Eagle Mountain, UT 84005 | 2018-01-08 |
| 1891201794 | Breaking Barriers Therapy Services LLC | Speech-Language Pathologist | 3756 E Barton Creek Dr, Eagle Mountain, UT 84005 | 2017-12-14 |
| 1346770617 | Mallory Lynn Hansen | Speech-Language Pathologist | 8981 N Skye Loop, Eagle Mountain, UT 84005 | 2017-06-19 |
| 1609315480 | Pony Express Dental LLC | Clinic/Center | 1308 E. Eagle Mountain Blvd, Eagle Mountain, UT 84005 | 2017-02-14 |
| 1609130418 | Utah Addiction Centers | Substance Abuse Rehabilitation Facility | 2590 Prarie View Drive, Eagle Mountain, UT 84005 | 2012-06-26 |
| 1760763411 | Elizabeth A Pritt | Physician Assistant | 4095 E Pony Express Parkway, Suite 1, Eagle Mountain, UT 84005 | 2011-09-07 |
| 1902101587 | Benjamin Dean Jones | Social Worker | 4682 East Foxwood Drive, Eagle Mountain, UT 84005 | 2011-01-13 |
| 1407182892 | Jacob Chase Fowler | Pharmacist | 3435 E Pony Express Pkwy Ste 150, Eagle Mountain, UT 84005 | 2009-10-20 |
| Find all providers in zip 84005 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144872516 | Davis Behavioral Health Inc | Community Based Residential Treatment Facility, Mental Illness | 2250 N Robins Dr, Layton, UT 84041-1140 | 2019-07-15 |
| 1710444245 | New Focus Academy | Community Based Residential Treatment Facility, Mental Illness | 1268 N Valley Heights Cir, Heber City, UT 84032-4591 | 2019-02-20 |
| 1871066365 | Sundance Canyon East | Community Based Residential Treatment Facility, Mental Illness | 11457 S 700 W, Draper, UT 84020-9426 | 2019-01-07 |
| 1508307083 | Jennifer Carlson | Community Based Residential Treatment Facility, Mental Illness | 8375 South 700east, Sandy, UT 84070 | 2017-03-16 |
| 1932646148 | Canyon River Ranch | Community Based Residential Treatment Facility, Mental Illness | 244 Ogden Cyn, Ogden, UT 84401-0958 | 2017-01-25 |
| 1629513833 | Telos | Community Based Residential Treatment Facility, Mental Illness | 661 S 1200 W, Orem, UT 84058-5817 | 2016-12-23 |
| 1982150256 | Sequel Youth Services of Falcon Ridge Ranch | Community Based Residential Treatment Facility, Mental Illness | 633 East Highway, Virgin, UT 84779 | 2016-08-28 |
| 1073069340 | Sequel Youth Services of Mt. Pleasant | Community Based Residential Treatment Facility, Mental Illness | 1100 South 70 West, Mt. Pleasant, UT 84647 | 2016-08-28 |
| 1942667597 | Mosaic House- Certs | Community Based Residential Treatment Facility, Mental Illness | 1488 E Vine St, Murray, UT 84121-1958 | 2016-01-26 |
| 1427425859 | Gateway Academy, LLC | Community Based Residential Treatment Facility, Mental Illness | 2487 S 700 E, Salt Lake City, UT 84106-1722 | 2015-09-02 |
| Find all providers with the same taxonomy | ||||
| City | EAGLE MOUNTAIN |
| Zip Code | 84005 |
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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.