Provider Demographics
NPI:1073829057
Name:UNIVERSAL HEALTHSERVICES INC.
Entity Type:Organization
Organization Name:UNIVERSAL HEALTHSERVICES INC.
Other - Org Name:PROVO CANYON SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-229-1036
Mailing Address - Street 1:1350 E 750 N
Mailing Address - Street 2:NORTH OREM MEDICAID
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4345
Mailing Address - Country:US
Mailing Address - Phone:801-227-2100
Mailing Address - Fax:
Practice Address - Street 1:1350 E 750 N
Practice Address - Street 2:NORTH OREM MEDICAID
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-4345
Practice Address - Country:US
Practice Address - Phone:801-227-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT126677-3902322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1609843523Medicaid