1417488040 NPI number — RIVERWOODS BEHAVIORAL HEALTH PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417488040 NPI number — RIVERWOODS BEHAVIORAL HEALTH PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERWOODS BEHAVIORAL HEALTH PC
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:
1417488040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 970392
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OREM
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84097-0392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-367-8076
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5314 RIVER RUN DR STE 350
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVO
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84604-7708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-787-9855
Provider Business Practice Location Address Fax Number:
801-228-1756
Provider Enumeration Date:
03/24/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HOYME
Authorized Official First Name:
LOUISE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE BILLIING MANAGER
Authorized Official Telephone Number:
801-367-8076

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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