1366879793 NPI number — SUNDANCE CANYON INC

Table of content: (NPI 1366879793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366879793 NPI number — SUNDANCE CANYON INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNDANCE CANYON INC
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:
SUNDANCE CANYON TREATMENT
Provider Other Organization Name Type Code:
3
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:
1366879793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1766 LITTLE SWEDEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANIEL
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84032-3505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-671-4444
Provider Business Mailing Address Fax Number:
435-503-8781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
182 N 775 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMERICAN FORK
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84003-2068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-473-6606
Provider Business Practice Location Address Fax Number:
801-763-5758
Provider Enumeration Date:
09/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HOOPER
Authorized Official First Name:
SHERI
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCIAL DIRECTOR
Authorized Official Telephone Number:
801-473-6606

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X , with the licence number:  3021 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 324500000X , with the licence number: 3021 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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