SALT CREEK ADDICTION RECOVERY SERVICES (NPI# 1639565260) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639565260 |
| Entity Type | Organization |
| Organization Name | SALT CREEK ADDICTION RECOVERY SERVICES |
| Practice Address |
21360 N 1450 E Moroni UT 84646 |
| Mailing Address |
Po Box 316 Moroni UT 84646 |
| Practice Telephone | 4352620891 |
| Mailing Telephone | 4352620891 |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2015-04-10 |
| Authorized Official Name | KEVIN ROGER BAILEY (DIRECTOR/OWNER) |
| Authorized Official Telephone | 4352620891 |
| Authorized Official Credential | CMCH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3245S0500X |
Substance Abuse Rehabilitation Facility Specialization: Substance Abuse Treatment, Children |
15W91838 | UT | Residential Treatment Facilities |
| Street Address |
21360 N 1450 E |
| City | MORONI |
| State | UT |
| Zip Code | 84646 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124328349 | Lance Irons | Counselor | 21360 N 1450 E, Moroni, UT 84646-0383 | 2010-10-22 |
| 1114448362 | Amy Ruth Brown | Counselor | 21360 N 1450 E, Moroni, UT 84646-0461 | 2017-06-28 |
| 1508386608 | Katie Cranford | Counselor | 21360 N 1450 E, Moroni, UT 84646-0461 | 2017-06-21 |
| 1366978827 | Jake Paxman | Counselor | 21360 N 1450 E, Moroni, UT 84646-0461 | 2017-05-03 |
| 1437685906 | Erick Espinoza | Counselor | 21360 N 1450 E, Moroni, UT 84646-0461 | 2017-05-03 |
| 1902354335 | Melyn Lund | Community Health Worker | 21360 N 1450 E, Moroni, UT 84646-0461 | 2016-09-14 |
| 1518319102 | Aubree Bailey | Community Health Worker | 21360 N 1450 E, Moroni, UT 84646-0461 | 2016-07-07 |
| 1699120279 | Rocky Dettamanti | Counselor | 21360 N 1450 E, Moroni, UT 84646-0461 | 2016-05-02 |
| 1407201072 | Alicia Hill | Counselor | 21360 N 1450 E, Moroni, UT 84646-0461 | 2016-05-02 |
| 1417301011 | Jenessa Tuai | Counselor | 21360 N 1450 E, Moroni, UT 84646-0461 | 2016-04-20 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942727029 | Doug Lloyd Hopes | Counselor | 21630 North 1450 East, Morona, UT 84646 | 2017-08-29 |
| 1881002061 | Compass Academy Transitional Services LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4800 E 17160 N, Moroni, UT 84646 | 2014-07-31 |
| 1932534260 | Matthew Truman Johnson | Substance Abuse Rehabilitation Facility | 2860 E 19500 N, Moroni, UT 84646 | 2013-09-05 |
| 1457611766 | Samuel Paul Wilkey | Substance Abuse Rehabilitation Facility | 21360 N 1450e, Moroni, UT 84646 | 2012-05-21 |
| 1275828949 | Robert Duane Simonson | Social Worker | 4800 East 17160 North, Moroni, UT 84646 | 2011-06-10 |
| 1386950392 | Josh Wilkey | Community Health Worker | 4800 E. 17160 N, Moroni, UT 84646 | 2010-08-27 |
| 1891007886 | Compass Academy | Residential Treatment Facility, Emotionally Disturbed Children | 4800 E. 17160 N., Moroni, UT 84646 | 2010-07-08 |
| 1518906320 | Eileen Keenan Jackson | Family Medicine | 51 E Main St., Moroni, UT 84646 | 2006-06-06 |
| 1225537707 | Jessica Pay | Counselor | 2860 East 19500 North, Moroni, UT 84646 | 2018-02-09 |
| 1134628613 | Todd Pay | Counselor | 2860 East 19500 North, Moroni, UT 84646 | 2018-02-09 |
| Find all providers in zip 84646 | ||||
| Taxonomy Code | 3245S0500X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| Specialization | Substance Abuse Treatment, Children |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of children with disorders in the use of drugs, alcohol, and other substances. Medical and supportive counseling services and education services are included. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982972964 | Lighthouse Ranch | Substance Abuse Rehabilitation Facility | 21360 N 1450 E, Moroni, UT 84646-0461 | 2011-12-06 |
| 1679873897 | William Conner | Substance Abuse Rehabilitation Facility | 21260 N 1450 E, 21260 North 1450 East, Moroni, UT 84646-0383 | 2010-10-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952790099 | Lorraine Michelle Ivey | Substance Abuse Rehabilitation Facility | 115 N 200 E, Washington, UT 84780-1642 | 2015-01-13 |
| 1912328576 | Heather Jenkins | Substance Abuse Rehabilitation Facility | 6200 South 3809 West, Kearns, UT 84129 | 2013-12-30 |
| 1477819878 | Mt Pleasant Campus | Substance Abuse Rehabilitation Facility | 1170 South 70 West, Mt. Pleasant, UT 84647 | 2012-04-10 |
| 1821382318 | Terri Butcher | Substance Abuse Rehabilitation Facility | 66 North 180 West, Ephriam, UT 84627-1111 | 2011-06-02 |
| 1154641926 | Triumph Youth Services | Substance Abuse Rehabilitation Facility | 58 S 950 W, Brigham City, UT 84302-4424 | 2010-06-03 |
| 1922323203 | Catalyst Residential Treatment | Substance Abuse Rehabilitation Facility | 970 S 1025 W, Brigham City, UT 84302-6711 | 2010-03-30 |
| 1003014648 | Eagle Ranch Academy | Substance Abuse Rehabilitation Facility | 115 W 1470 S, St George, UT 84770-6763 | 2007-07-05 |
| 1780782508 | Northstar Youth Academy LLC | Substance Abuse Rehabilitation Facility | 900 Columbia Ln, Provo, UT 84604-1320 | 2006-09-20 |
| 1083073985 | Eric Peter Rydzewski | Substance Abuse Rehabilitation Facility | 344 E 100 S, Suite 301, Salt Lake City, UT 84111-1700 | 2016-02-19 |
| 1396169728 | Apex Youth Services | Substance Abuse Rehabilitation Facility | 8606 N 11600 W, Thatcher, UT 84337-9103 | 2014-02-05 |
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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.