CROSS CREEK MANOR (NPI# 1780900464) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780900464 |
| Entity Type | Organization |
| Organization Name | CROSS CREEK MANOR |
| Practice Address |
50 S State St La Verkin UT 84745-5443 |
| Practice Telephone | 4356352390 |
| Practice Fax Number | 4356352778 |
| Mailing Telephone | 4356352390 |
| Mailing Fax Number | 4356352778 |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2010-04-20 |
| Authorized Official Name | DERRICK ESPLIN (CPA) |
| Authorized Official Telephone | 4356352390 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | UT | Residential Treatment Facilities | |
| N | 323P00000X | Psychiatric Residential Treatment Facility | UT | Residential Treatment Facilities | |
| Y | 3245S0500X |
Substance Abuse Rehabilitation Facility Specialization: Substance Abuse Treatment, Children |
UT | Residential Treatment Facilities |
| Street Address |
50 S STATE ST |
| City | LA VERKIN |
| State | UT |
| Zip Code | 84745-5443 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 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 |
| 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 |
| 1356476873 | Cross Creek Manor, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 150 N State St, La Verkin, UT 84745-5503 | 2007-02-23 |
| 1609980739 | Hugh J Howard | Dentist | 144 S State St, La Verkin, UT 84745-5600 | 2006-08-18 |
| 1285113472 | North Star Center, LLC. | Clinic/Center | 254 S State St Bldg A, La Verkin, UT 84745-5633 | 2018-08-09 |
| Find all providers in zip 84745 | ||||
| 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 |
|---|---|---|---|---|
| 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 |
| 1639565260 | Salt Creek Addiction Recovery Services | Substance Abuse Rehabilitation Facility | 21360 N 1450 E, Moroni, UT 84646 | 2015-04-10 |
| 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.