NPIMap

Organization Active NPI

Four Corners Community Behavioral Health Inc

Doing business as Operation Recovery

  • Methadone Clinic
  • Price, UT
National Provider Identifier
1164048492
Registry record updated Jun 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
FOUR CORNERS COMMUNITY BEHAVIORAL HEALTH INC
Doing business as
Operation Recovery
Practice address
77 S 600 E
Price, UT 84501-3174
Phone
(435) 637-7289
NPI assigned
Jun 23, 2020
Last updated
Jun 23, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
FOUR CORNERS COMMUNITY BEHAVIORAL HEALTH INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 23, 2020

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

Authorized official

Name
Jeanie Willson
Title
Cfo
Phone
(435) 637-7200

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
Clinic Pharmacy 3336C0002X
Community/Behavioral Health Agency 251S00000X

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 1

  • Operation Recovery Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Opioid treatment program
Medicare-enrolled since Jun 10, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200928002126 UT Part B Supplier - Opioid Treatment Program (Otp) 2769377415 Practice locations: Price, UT

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D2296972Four Corners Community Behavioral Health77 South 600 East, Price, UT 84501Certificate of waiverJan 8, 2028

National Provider Directory

National Provider Directory
Tax ID family
Konrad P Kotrady MD2 organizations share this tax ID, including this one
Part of
Konrad P Kotrady MD

Other organizations with this tax ID 1

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

Locations

198 E Center St
Moab, UT 84532
Phone (435) 259-2432

575 E 1st S
Price, UT 84501
Phone (435) 637-2358

690 E Main St
Price, UT 84501
Phone (435) 637-2358

77 S 600 E
Ste C
Price, UT 84501
Phone (435) 613-7289

Practitioners & affiliated clinicians

Practitioners 227

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 227

NPI Registry JSON

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

{
    "created_epoch": "1592870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592870400000",
    "number": "1164048492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 867",
            "city": "PRICE",
            "state": "UT",
            "postal_code": "845010867",
            "telephone_number": "435-637-7200",
            "fax_number": "435-637-2377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 S 600 E",
            "city": "PRICE",
            "state": "UT",
            "postal_code": "845013174",
            "telephone_number": "435-637-7289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR CORNERS COMMUNITY BEHAVIORAL HEALTH INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FOUR CORNERS COMMUNITY BEHAVIORAL HEALTH INC",
        "enumeration_date": "2020-06-23",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A",
        "authorized_official_last_name": "WILLSON",
        "authorized_official_first_name": "JEANIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "435-637-7200"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Operation Recovery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Price, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.