Provider Demographics
NPI:1467605576
Name:UHS OF TIMPANOGOS, INC.
Entity Type:Organization
Organization Name:UHS OF TIMPANOGOS, INC.
Other - Org Name:CENTER FOR CHANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INPATIENT BILLING
Authorized Official - Prefix:
Authorized Official - First Name:GAY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-224-8255
Mailing Address - Street 1:1790 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2025
Mailing Address - Country:US
Mailing Address - Phone:801-224-8255
Mailing Address - Fax:801-224-8301
Practice Address - Street 1:1790 N STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2025
Practice Address - Country:US
Practice Address - Phone:801-224-8255
Practice Address - Fax:801-224-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2006-HOSP-72416323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000063626Medicare PIN