Bryce Canyon Academy of Utah, LLC

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

17338 Issued in UT

Legal business name

BRYCE CANYON ACADEMY OF UTAH, LLC

Practice address

580 N Main
Parowan, UT 84761

Phone

(435) 477-9167

NPI assigned

Nov 3, 2011

Last updated

Nov 3, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Travis Gary Milne

Title

Principal of Board

Phone

(435) 669-4884

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1320278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320278400000",
    "number": "1457638587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 967",
            "city": "PAROWAN",
            "state": "UT",
            "postal_code": "847610967",
            "telephone_number": "435-477-9167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 N MAIN",
            "city": "PAROWAN",
            "state": "UT",
            "postal_code": "84761",
            "telephone_number": "435-477-9167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRYCE CANYON ACADEMY OF UTAH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-03",
        "last_updated": "2011-11-03",
        "status": "A",
        "authorized_official_last_name": "MILNE",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "GARY",
        "authorized_official_title_or_position": "PRINCIPAL OF BOARD",
        "authorized_official_telephone_number": "435-669-4884",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "UT",
            "license": "17338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Emotionally Disturbed Childrens' Residential Treatment Facility in Parowan, UT
• Providers in Parowan, UT by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; 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.