BRYANT DAVIS (NPI# 1932460102) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932460102 |
| Entity Type | Individual |
| Full Name | BRYANT DAVIS |
| Practice Address |
21360 North 1450 East Moroni UT 84646 |
| Mailing Address |
P.o. Box 461 21360 North 1450 East Moroni UT 84646 |
| Practice Telephone | 4354455200 |
| Mailing Telephone | 4354455200 |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2012-06-05 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 272503815 | UT | Residential Treatment Facilities |
| Street Address |
21360 NORTH 1450 EAST |
| City | MORONI |
| State | UT |
| Zip Code | 84646 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235458555 | Lighthouse Ranch LLC | Substance Abuse Rehabilitation Facility | 21360 North 1450 East, Moroni, UT 84646-0461 | 2010-05-26 |
| 1669985669 | Michael Raymond Hamm Jr. | Counselor | 21360 North 1450 East, Moroni, UT 84646461 | 2017-11-13 |
| 1346602133 | Shandi Child Michael | Counselor | 21360 North 1450 East, Moroni, UT 84646 | 2016-03-22 |
| 1427423680 | Roger Bailey | Counselor | 21360 North 1450 East, Moroni, UT 84646 | 2015-12-14 |
| 1053738567 | Mark Puett | Counselor | 21360 North 1450 East, Moroni, UT 84646-0461 | 2014-03-21 |
| 1730421439 | Milton Scott Harmon | Developmental Therapist | 21360 North 1450 East, Moroni, UT 84646-0461 | 2013-03-20 |
| 1366796153 | Josh Verland Jensen | Counselor | 21360 North 1450 East, Bluehills, Moroni, UT 84646-0461 | 2012-11-01 |
| 1649578444 | Jami Whitwell | Counselor | 21360 North 1450 East, Moroni, UT 84646 | 2011-03-03 |
| 1477851277 | Daniel Dalene | Counselor | 21360 North 1450 East, Moroni, UT 84646 | 2011-03-03 |
| 1548562838 | Kevin Bailey | Counselor | 21360 North 1450 East, Moroni, UT 84646-0461 | 2010-11-19 |
| Find all providers in the same location | ||||
| 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 | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336556638 | Bryan Holder | Substance Abuse Rehabilitation Facility | 21360 N 1460 E, Moroni, UT 84646-0461 | 2014-07-18 |
| 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 |
| 1235458555 | Lighthouse Ranch LLC | Substance Abuse Rehabilitation Facility | 21360 North 1450 East, Moroni, UT 84646-0461 | 2010-05-26 |
| 1447579115 | Lighthouse Academy LLC | Substance Abuse Rehabilitation Facility | 21260 N. 1450 E., Moroni, UT 84646-0383 | 2010-05-20 |
| 1316314081 | Ethan Colburn | Substance Abuse Rehabilitation Facility | 21360 N 1450 E, Moroni, UT 84646-0461 | 2015-08-28 |
| 1336523695 | Blue Hills Residential Treatment | Substance Abuse Rehabilitation Facility | 2860 East 19500 North, Moroni, UT 84646-0461 | 2015-07-16 |
| 1770960411 | Blue Hills Residential Treatment | Substance Abuse Rehabilitation Facility | 21360 N 1450 E, Moroni, UT 84646-0461 | 2015-05-01 |
| 1720465727 | Blue Hills Residential Treatment | Substance Abuse Rehabilitation Facility | 21360 N 1450 E, Moroni, UT 84646-0461 | 2015-04-29 |
| 1629497458 | James Beasley | Substance Abuse Rehabilitation Facility | 21360 N 1450 E, Moroni, UT 84646 | 2014-04-09 |
| Find all providers in MORONI | ||||
Please comment or provide details below to improve the information on BRYANT DAVIS.
| 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.