NPIMap

Organization Active NPI

The Phoenix Recovery & Counseling Center - Riverdale

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Riverdale, UT
National Provider Identifier
1346600293
Registry record updated Mar 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
19186 Issued in UT
Legal business name
THE PHOENIX RECOVERY & COUNSELING CENTER - RIVERDALE
Practice address
5133 S 1500 W
Riverdale, UT 84405-3926
Phone
(801) 392-0895
Fax
(801) 619-2016
NPI assigned
Mar 3, 2016
Organization subpart
Yes
Parent organization
THE PHOENIX RECOVERY CENTER, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 3, 2016

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

Authorized official

Name
Mr. Brad Randall Christensen
Title
Operations Director
Phone
(801) 571-6798

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101Y00000X 19186 UT
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X 19186 UT
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X 19186 UT
Professional CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YP2500X 19186 UT
Behavior AnalystGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103K00000X 19186 UT
Adult Mental Health Clinic/Center 261QM0850X 19186 UT
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 19186 UT Primary

Addresses

Primary practice location

5133 S 1500 W
Riverdale, UT 84405-3926

Mailing address

5133 S 1500 W
Riverdale, UT 84405-3926
Phone (801) 392-0895

National Provider Directory

National Provider Directory
Tax ID family
The Phoenix Recovery Counseling Center - Riverdale8 organizations share this tax ID, including this one
Part of
The Phoenix Recovery Counseling Center - Riverdale

Other organizations with this tax ID 7

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

NPI Registry JSON

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

{
    "created_epoch": "1456963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456963200000",
    "number": "1346600293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5133 S 1500 W",
            "city": "RIVERDALE",
            "state": "UT",
            "postal_code": "844053926",
            "telephone_number": "801-392-0895",
            "fax_number": "801-619-2016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5133 S 1500 W",
            "city": "RIVERDALE",
            "state": "UT",
            "postal_code": "844053926",
            "telephone_number": "801-392-0895",
            "fax_number": "801-619-2016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PHOENIX RECOVERY & COUNSELING CENTER - RIVERDALE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE PHOENIX RECOVERY CENTER, LLC",
        "enumeration_date": "2016-03-03",
        "last_updated": "2016-03-03",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "RANDALL",
        "authorized_official_title_or_position": "OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "801-571-6798",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "UT",
            "license": "19186",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "UT",
            "license": "19186",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "19186",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "UT",
            "license": "19186",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": "UT",
            "license": "19186",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "UT",
            "license": "19186",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "UT",
            "license": "19186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2016; 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.