NPIMap

Organization Active NPI

DDMS of Utah No.2

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • West Valley City, UT
National Provider Identifier
1558730218
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-101 Issued in UT
Legal business name
DDMS OF UTAH NO.2
Doing business as
West Side Center
Practice address
4028 S 4800 W
West Valley City, UT 84120-4537
Phone
(801) 968-8122
Fax
(801) 968-8135
NPI assigned
Sep 23, 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-101 UT Primary

Addresses

Primary practice location

4028 S 4800 W
West Valley City, UT 84120-4537

Mailing address

4028 S 4800 W
West Valley City, UT 84120-4537
Phone (801) 968-8122

Other identifiers 1

IdentifierTypeStateIssuer
2015-SHCF-101MedicaidUT

Other names 1

  • West 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

4028 S 4800 W
West Valley City, UT 84120
Phone (801) 968-8122

NPI Registry JSON

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

{
    "created_epoch": "1442966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686182400000",
    "number": "1558730218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4028 S 4800 W",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841204537",
            "telephone_number": "801-968-8122",
            "fax_number": "801-968-8135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4028 S 4800 W",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841204537",
            "telephone_number": "801-968-8122",
            "fax_number": "801-968-8135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DDMS OF UTAH NO.2",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-23",
        "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-101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2015-SHCF-101",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Side Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West Side Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Valley City, 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.