Provider Demographics
NPI:1518067578
Name:CINNAMON HILLS YOUTH CRISIS CENTER
Entity Type:Organization
Organization Name:CINNAMON HILLS YOUTH CRISIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BUFF
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-674-0984
Mailing Address - Street 1:770 E SAINT GEORGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3034
Mailing Address - Country:US
Mailing Address - Phone:435-674-0984
Mailing Address - Fax:
Practice Address - Street 1:770 E SAINT GEORGE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3034
Practice Address - Country:US
Practice Address - Phone:435-674-0984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11761323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1198441600Medicaid
AKHS781PIMedicaid
PA0017985550001Medicaid
UT788007788153Medicaid