Provider Demographics
NPI:1649380593
Name:KIDS BEHAVIORAL HEALTH OF UTAH, INC
Entity Type:Organization
Organization Name:KIDS BEHAVIORAL HEALTH OF UTAH, INC
Other - Org Name:COPPER HILLS YOUTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SRVPCFO
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:610-738-3300
Mailing Address - Street 1:5899 RIVENDELL DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5700
Mailing Address - Country:US
Mailing Address - Phone:801-561-3377
Mailing Address - Fax:801-569-3274
Practice Address - Street 1:5899 RIVENDELL DR
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5700
Practice Address - Country:US
Practice Address - Phone:801-561-3377
Practice Address - Fax:801-569-3274
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UHS OF DELAWARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11944322D00000X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND55513Medicaid
NM98139363Medicaid
WY117906300Medicaid
AZ596661Medicaid
AKHS825PIMedicaid
NV006388500Medicaid