Four Corners Community Behavioral Health Inc
Organization Active NPI Methadone Clinic · Price, UT
NPI 1164048492 · NPPES record last updated Jun 23, 2020
Key facts
- NPI
- 1164048492
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Methadone Clinic 261QM2800X
- Legal business name
- FOUR CORNERS COMMUNITY BEHAVIORAL HEALTH INC
- Practice address
- 77 S 600 E
Price, UT 84501-3174 - Phone
- (435) 637-7289
- NPI assigned
- Jun 23, 2020
- Organization subpart
- Yes
- Parent organization (as reported)
- FOUR CORNERS COMMUNITY BEHAVIORAL HEALTH INC
Authorized official
- Name
- Jeanie Willson
- Title
- Cfo
- Phone
- (435) 637-7200
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Practitioners 198
-
Andrea D. Barney, APRN
-
Kelland Jay Brewer, CSW
-
Cheri Engberson, CSW
-
Michele Marie Huff, CSW MSW
-
Aja Elizabeth Lyman, MSW
-
Alison Marrelli, LCSW
-
Tiffany Brook Noyes, DNP, APRN, FNP-BC
-
William Blake Paul, M.A., L.M.F.T.
-
Andrew Rice, DNP, APRN
-
Zoe Atalie Robbins, NURSE PRACTITIONER
-
Meranda Saccomano, CSW
-
Karen Dolan, LCSW
-
Jeannee Hunt, PAC
-
Lakecia Wilkinson, PA-C
-
Kourtney Atwood, APRN
-
Michael Roy Lowry, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 46D2296972 | Four Corners Community Behavioral Health | Certificate of waiver | Jan 8, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Opioid treatment program
- Medicare-enrolled since Jun 10, 2020
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200928002126 | UT | Part B Supplier - Opioid Treatment Program (Otp) | 2769377415 | Practice locations: Price, UT |
National Provider Directory
- Tax ID family
- Four Corners Com Behavi
- Part of
- Four Corners Com Behavi
Locations
77 S 600 E
Ste C
Price, UT 84501
Phone (435) 613-7289
575 E 1st S
Price, UT 84501
Phone (435) 637-2358
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | |||
| Methadone Clinic | 261QM2800X | Yes | ||
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | |||
| Clinic Pharmacy | 3336C0002X |
Addresses
Primary practice location
77 S 600 E
Price, UT 84501-3174
Mailing address
PO Box 867
Price, UT 84501-0867
Phone (435) 637-7200
Other names
- Operation Recovery
Other providers in Price, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.