Provider Demographics
NPI:1629714845
Name:CASTLE RIDGE BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:CASTLE RIDGE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-381-4357
Mailing Address - Street 1:65 E 100 N
Mailing Address - Street 2:
Mailing Address - City:CASTLE DALE
Mailing Address - State:UT
Mailing Address - Zip Code:84513
Mailing Address - Country:US
Mailing Address - Phone:435-381-4357
Mailing Address - Fax:
Practice Address - Street 1:65 E 100 N
Practice Address - Street 2:
Practice Address - City:CASTLE DALE
Practice Address - State:UT
Practice Address - Zip Code:84513
Practice Address - Country:US
Practice Address - Phone:435-381-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty