Provider Demographics
NPI:1760777221
Name:PAINTED HILLS ACADEMY
Entity Type:Organization
Organization Name:PAINTED HILLS ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CECIL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:885-861-2263
Mailing Address - Street 1:680 WEST 300 SOUTH
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:UT
Mailing Address - Zip Code:84751-0516
Mailing Address - Country:US
Mailing Address - Phone:855-861-2263
Mailing Address - Fax:435-387-2499
Practice Address - Street 1:680 WEST 300 SOUTH
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:UT
Practice Address - Zip Code:84751-0516
Practice Address - Country:US
Practice Address - Phone:855-861-2263
Practice Address - Fax:435-387-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT18054322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children