Provider Demographics
NPI:1750847000
Name:SCENIC VIEW ACADEMY, INC.
Entity Type:Organization
Organization Name:SCENIC VIEW ACADEMY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES
Authorized Official - Prefix:MR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-226-2550
Mailing Address - Street 1:5455 RIVER RUN DR
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-7726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5455 RIVER RUN DR
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-7726
Practice Address - Country:US
Practice Address - Phone:801-226-2550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT51120OtherSTATE OF UTAH DEPARTMENT OF HUMAN SERVICES OFFICE OF LICENSING
UT51122OtherSTATE OF UTAH DEPARTMENT OF HUMAN SERVICES OFFICE OF LICENSING
UT51121OtherSTATE OF UTAH DEPARTMENT OF HUMAN SERVICES OFFICE OF LICENSING