Provider Demographics
NPI:1376772285
Name:WEST RIDGE ACADEMY
Entity Type:Organization
Organization Name:WEST RIDGE ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-282-1000
Mailing Address - Street 1:5500 BAGLEY PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-5697
Mailing Address - Country:US
Mailing Address - Phone:801-282-1000
Mailing Address - Fax:801-282-1198
Practice Address - Street 1:5500 BAGLEY PARK RD
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-5697
Practice Address - Country:US
Practice Address - Phone:801-282-1000
Practice Address - Fax:801-282-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14991322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4091347Medicaid