NPIMap

Organization Active NPI

Utah Valley Family Support Center Inc

  • Clinical Social Worker
  • Orem, UT
National Provider Identifier
1306915541
Registry record updated Feb 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
11417 Issued in UT
Legal business name
UTAH VALLEY FAMILY SUPPORT CENTER INC
Practice address
1255 N 1200 W
Orem, UT 84057-2445
Phone
(801) 229-1181
Fax
(801) 229-2787
NPI assigned
Nov 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2019

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

Authorized official

Name
Ruth M Mitsuda
Title
Business Manager
Phone
(801) 229-1181

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 11417 UT Primary

Addresses

Primary practice location

1255 N 1200 W
Orem, UT 84057-2445

Mailing address

1255 N 1200 W
Orem, UT 84057-2445
Phone (801) 229-1181

Other identifiers 1

IdentifierTypeStateIssuer
788007788265MedicaidUT

Other names 2

  • Family Support & Treatment Center INC Doing business as
  • Family Support & Treatment Center Inc. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050830000986 UT Part B Supplier - Clinic/Group Practice 0749211613 Receives reassigned benefits from 2 practitioners
Practice locations: Orem, UT

National Provider Directory

National Provider Directory
Tax ID family
Family Support Treatment Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1255 N 1200 W
Orem, UT 84057
Phone (801) 229-1181

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549929600000",
    "number": "1306915541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1255 N 1200 W",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840572445",
            "telephone_number": "801-229-1181",
            "fax_number": "801-229-2787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 N 1200 W",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840572445",
            "telephone_number": "801-229-1181",
            "fax_number": "801-229-2787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UTAH VALLEY FAMILY SUPPORT CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2019-02-12",
        "status": "A",
        "authorized_official_last_name": "MITSUDA",
        "authorized_official_first_name": "RUTH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "801-229-1181"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "11417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "788007788265",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Support & Treatment Center INC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Support & Treatment Center Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orem, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.