1720140114 NPI number — UNI BEHAVIORAL HEALTH CLINICS

Table of content: (NPI 1720140114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720140114 NPI number — UNI BEHAVIORAL HEALTH CLINICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNI BEHAVIORAL HEALTH CLINICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720140114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 413076
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84141-3076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-585-1212
Provider Business Mailing Address Fax Number:
801-585-9096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 KOMAS DR
Provider Second Line Business Practice Location Address:
208
Provider Business Practice Location Address City Name:
SLC
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84108-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-585-1212
Provider Business Practice Location Address Fax Number:
801-585-9096
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUSHTON-FOWLER
Authorized Official First Name:
JEANNINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTRACTING DIRECTOR
Authorized Official Telephone Number:
801-587-6336

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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