Provider Demographics
NPI:1942415666
Name:UTAH PREPARATORY ACADEMY
Entity Type:Organization
Organization Name:UTAH PREPARATORY ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-835-4475
Mailing Address - Street 1:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:MANTI
Mailing Address - State:UT
Mailing Address - Zip Code:84642-0243
Mailing Address - Country:US
Mailing Address - Phone:435-835-4475
Mailing Address - Fax:435-835-4474
Practice Address - Street 1:920 NORTH 0000 EAST-WEST
Practice Address - Street 2:
Practice Address - City:MANTI
Practice Address - State:UT
Practice Address - Zip Code:84642
Practice Address - Country:US
Practice Address - Phone:435-835-4475
Practice Address - Fax:435-835-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12683322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children