Provider Demographics
NPI:1891209490
Name:SUNDANCE CANYON TREATMENT
Entity Type:Organization
Organization Name:SUNDANCE CANYON TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-473-6606
Mailing Address - Street 1:32 SLEDHILL CIR
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1488
Mailing Address - Country:US
Mailing Address - Phone:801-473-6606
Mailing Address - Fax:
Practice Address - Street 1:6948 W DUSTY ROSE CIR
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-4710
Practice Address - Country:US
Practice Address - Phone:801-473-6606
Practice Address - Fax:801-763-5758
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNDANCE CANYON INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52530261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health