Provider Demographics
NPI:1609843523
Name:UHS PROVO CANYON INC
Entity Type:Organization
Organization Name:UHS PROVO CANYON INC
Other - Org Name:PROVO CANYON SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/ SR VP
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:4501 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5504
Mailing Address - Country:US
Mailing Address - Phone:800-848-9819
Mailing Address - Fax:
Practice Address - Street 1:4501 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5504
Practice Address - Country:US
Practice Address - Phone:800-848-9819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11043323P00000X
UT3701323P00000X
UT3699323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000M0056Medicaid
UT131599140Medicaid