NPIMap

Organization Active NPI

Makana Leadership Academy

  • Adolescent and Children Mental Health Clinic/Center
  • Roosevelt, UT
National Provider Identifier
1467077750
Registry record updated Jun 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
MAKANA LEADERSHIP ACADEMY
Practice address
4270 W 5625 N
Roosevelt, UT 84066-4824
Phone
(435) 353-4498
Fax
(435) 353-4898
NPI assigned
Jun 11, 2020
Last updated
Jun 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2020

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

Authorized official

Name
Ms. Sharon K Sperry-Clegg, MA
Title
Compliance Director
Phone
(801) 859-3505

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X NU
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU Primary
Mental Illness Intermediate Care Facility 310500000X NU
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X NU
Children's Substance Abuse Rehabilitation Facility 3245S0500X NU
Clinical Social Worker 1041C0700X NU
Lodging Provider 177F00000X NU
Meals Provider 174200000X NU

Addresses

Primary practice location

4270 W 5625 N
Roosevelt, UT 84066-4824

Mailing address

4270 W 5625 N
Roosevelt, UT 84066-4824
Phone (435) 353-4498

National Provider Directory

National Provider Directory

Locations

4270 W 5625 N
Roosevelt, UT 84066
Phone (435) 353-4498

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1591833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591833600000",
    "number": "1467077750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4270 W 5625 N",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840664824",
            "telephone_number": "435-353-4498",
            "fax_number": "435-353-4898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4270 W 5625 N",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840664824",
            "telephone_number": "435-353-4498",
            "fax_number": "435-353-4898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAKANA LEADERSHIP ACADEMY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-11",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A",
        "authorized_official_last_name": "SPERRY-CLEGG",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "COMPLIANCE DIRECTOR",
        "authorized_official_telephone_number": "801-859-3505",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "177F00000X",
            "taxonomy_group": "",
            "desc": "Lodging",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "174200000X",
            "taxonomy_group": "",
            "desc": "Meals",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roosevelt, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2020; 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.