Evolution Academy of Utah LLC

Primary specialty

Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X

License

11353 Issued in UT

Legal business name

EVOLUTION ACADEMY OF UTAH LLC

Doing business as

Cottonwood Treatment Center

Practice address

1144 W 3300 S
Salt Lake City, UT 84119-7175

Phone

(801) 433-2900

Fax

(801) 433-2999

NPI assigned

Nov 10, 2006

Last updated

Aug 22, 2020By 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. James Bailey

Title

C.E.O.

Phone

(801) 433-2900

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• Cottonwood Treatment Center Doing business as

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1558432849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1144 W 3300 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841197175",
            "telephone_number": "801-433-2900",
            "fax_number": "801-433-2999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1144 W 3300 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841197175",
            "telephone_number": "801-433-2900",
            "fax_number": "801-433-2999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLUTION ACADEMY OF UTAH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "801-433-2900",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "UT",
            "license": "11353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5168120",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55880347",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4766",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HS339PI",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810005990",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4103783",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cottonwood Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Evolutionary Healthcare LLC
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• Evolve Emod LLC
• Lacey Dru Eward
• Briana Ewell

• Psychiatric Residential Treatment Facility in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Psychiatric Residential Treatment Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.