Provider Demographics
NPI:1467077750
Name:MAKANA LEADERSHIP ACADEMY
Entity Type:Organization
Organization Name:MAKANA LEADERSHIP ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:SPERRY-CLEGG
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:801-859-3505
Mailing Address - Street 1:4270 W 5625 N
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066-4824
Mailing Address - Country:US
Mailing Address - Phone:435-353-4498
Mailing Address - Fax:435-353-4898
Practice Address - Street 1:4270 W 5625 N
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066-4824
Practice Address - Country:US
Practice Address - Phone:435-353-4498
Practice Address - Fax:435-353-4898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children