Provider Demographics
NPI:1316009228
Name:VALLEY MENTAL HEALTH INCORPORATED
Entity Type:Organization
Organization Name:VALLEY MENTAL HEALTH INCORPORATED
Other - Org Name:VMH - PHEASANT HOLLOW
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:LARCENAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-263-7186
Mailing Address - Street 1:PO BOX 572070
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84157-2070
Mailing Address - Country:US
Mailing Address - Phone:801-263-7138
Mailing Address - Fax:801-263-7203
Practice Address - Street 1:4125 S 900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1112
Practice Address - Country:US
Practice Address - Phone:801-743-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12009320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities