Provider Demographics
NPI:1467552877
Name:KIDS BEHAVIORAL HEALTH OF UTAH
Entity Type:Organization
Organization Name:KIDS BEHAVIORAL HEALTH OF UTAH
Other - Org Name:COPPER HILLS YOUTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-561-3377
Mailing Address - Street 1:5899 RIVENDELL DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5700
Mailing Address - Country:US
Mailing Address - Phone:801-561-3377
Mailing Address - Fax:
Practice Address - Street 1:5899 RIVENDELL DR
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5700
Practice Address - Country:US
Practice Address - Phone:801-561-3377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11944323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility