Provider Demographics
NPI:1518460369
Name:UINTA ACADEMY RTC, LLC
Entity Type:Organization
Organization Name:UINTA ACADEMY RTC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-890-2857
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84339-0387
Mailing Address - Country:US
Mailing Address - Phone:435-245-2600
Mailing Address - Fax:435-245-2605
Practice Address - Street 1:3746 S 4800 W
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84339-9785
Practice Address - Country:US
Practice Address - Phone:435-245-2600
Practice Address - Fax:435-245-2605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51635323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility