Organization Name: | SUNDANCE CANYON ACADEMY |
NPI Number: | 1023318300 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | REYNIE THOMAS SANDOVAL (CLINICAL DIRECTOR) |
Mailing Address: | 6948 Dusty Rose Dr Herriman |
State: | UT US |
Postal Code: | 840964710 |
Phone Number: | 8014466206 |
Fax Number: | 8014466978 |
NPI Enumeration Date: | 11/02/2010 |
NPI Last Update Date: | 11/02/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320800000X |
License Number: | 17166 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |