Provider Demographics
NPI:1629447370
Name:RHA HEALTH SERVICE UT LLC
Entity Type:Organization
Organization Name:RHA HEALTH SERVICE UT LLC
Other - Org Name:EAST SIDE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-763-9299
Mailing Address - Street 1:642 S UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3213
Mailing Address - Country:US
Mailing Address - Phone:801-582-2195
Mailing Address - Fax:801-582-3901
Practice Address - Street 1:650 S UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-3213
Practice Address - Country:US
Practice Address - Phone:801-582-2195
Practice Address - Fax:801-582-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2015SHCF-22320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT2015-SHVF-158Medicaid
UT46D0977163OtherCLIA