NPIMap

Organization Active NPI

Sundance Canyon Academy

  • Mental Illness Community Based Residential Treatment Facility
  • Herriman, UT
National Provider Identifier
1023318300
Registry record updated Nov 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
17166 Issued in UT
Legal business name
SUNDANCE CANYON ACADEMY
Practice address
6948 Dusty Rose Dr
Herriman, UT 84096-4710
Phone
(801) 446-6206
Fax
(801) 446-6978
NPI assigned
Nov 2, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Reynie Thomas Sandoval, LCSW
Title
Clinical Director
Phone
(801) 735-6407

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 17166 UT Primary

Addresses

Primary practice location

6948 Dusty Rose Dr
Herriman, UT 84096-4710

Mailing address

6948 Dusty Rose Dr
Herriman, UT 84096-4710
Phone (801) 446-6206

National Provider Directory

National Provider Directory
Tax ID family
Sundance Canyon Academy4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288656000000",
    "number": "1023318300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6948 DUSTY ROSE DR",
            "city": "HERRIMAN",
            "state": "UT",
            "postal_code": "840964710",
            "telephone_number": "801-446-6206",
            "fax_number": "801-446-6978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6948 DUSTY ROSE DR",
            "city": "HERRIMAN",
            "state": "UT",
            "postal_code": "840964710",
            "telephone_number": "801-446-6206",
            "fax_number": "801-446-6978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNDANCE CANYON ACADEMY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-02",
        "last_updated": "2010-11-02",
        "status": "A",
        "authorized_official_last_name": "SANDOVAL",
        "authorized_official_first_name": "REYNIE",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "801-735-6407",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "UT",
            "license": "17166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Herriman, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.