NPIMap

Organization Active NPI

DDMS of Utah No.2

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Bountiful, UT
National Provider Identifier
1326418328
Registry record updated Jun 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
2015-SHCF-344 Issued in UT
Legal business name
DDMS OF UTAH NO.2
Practice address
340 N 100 W
Bountiful, UT 84010-6054
Phone
(801) 292-6797
Fax
(801) 295-3660
NPI assigned
Oct 2, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2023

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

Authorized official

Name
Misti Ann Buck, D.O./ADMINISTRATOR
Title
Director of Operations
Phone
(801) 763-9299

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 2015-SHCF-344 UT Primary

Addresses

Primary practice location

340 N 100 W
Bountiful, UT 84010-6054

Mailing address

119 S Pacific Dr
119
American Fork, UT 84003-2196
Phone (801) 763-9299

Other identifiers 1

IdentifierTypeStateIssuer
2015-SHCF-344MedicaidUT

Other names 1

  • North Side Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
DDMS of Utah No27 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

119 S Pacific Dr
#119
American Fork, UT 84003

NPI Registry JSON

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

{
    "created_epoch": "1443744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686182400000",
    "number": "1326418328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 S PACIFIC DR",
            "address_2": "119",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840032196",
            "telephone_number": "801-763-9299",
            "fax_number": "801-763-1121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 N 100 W",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840106054",
            "telephone_number": "801-292-6797",
            "fax_number": "801-295-3660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DDMS OF UTAH NO.2",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-02",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A",
        "authorized_official_last_name": "BUCK",
        "authorized_official_first_name": "MISTI",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "801-763-9299",
        "authorized_official_credential": "D.O./ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "UT",
            "license": "2015-SHCF-344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2015-SHCF-344",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Side Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Side Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bountiful, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; 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.