Caleb Rose – Counselor in Moroni, UT

Key facts

NPI: 1134591597
Entity type: Individual (NPI type 1)
Primary specialty: Counselor 101Y00000X
Practice address: 2860 East 19500 North
Moroni, UT 84646-0461
Phone: (435) 436-9029
Fax: (435) 445-5201
NPI assigned: Oct 26, 2015
Sex: Male
Sole proprietor: No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Blue Hills Residential Treatment Substance Abuse Rehabilitation Facility · Moroni, UT · NPI 1336523695

NPD (past)
Lighthouse Ranch Corporation Substance Abuse Rehabilitation Facility · Ephraim, UT · NPI 1992079099

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Practice roles

Organization	Specialty	Status	New patients
Blue Hills Residential Treatment		Past	Accepting new patients
Lighthouse Ranch Corporation		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Counselor	101Y00000X			Yes

Addresses

Primary practice location

2860 East 19500 North
Moroni, UT 84646-0461

Mailing address

PO Box 461
Moroni, UT 84646-0461
Phone (435) 436-9029

Other identifiers

Identifier	Type	State	Issuer
1235458555	Medicaid	UT

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 26, 2015.

{
    "created_epoch": "1445817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445817600000",
    "number": "1134591597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 461",
            "city": "MORONI",
            "state": "UT",
            "postal_code": "846460461",
            "telephone_number": "435-436-9029",
            "fax_number": "435-445-5201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2860 EAST 19500 NORTH",
            "city": "MORONI",
            "state": "UT",
            "postal_code": "846460461",
            "telephone_number": "435-436-9029",
            "fax_number": "435-445-5201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "CALEB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-10-26",
        "last_updated": "2015-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235458555",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moroni, UT

All providers in Moroni, UT · Counselor in Utah

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2015. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.