NPIMap

Organization Active NPI

Trevor Hansen

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Moroni, UT
National Provider Identifier
1699199935
Registry record updated Feb 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
TREVOR HANSEN
Practice address
21260 N. 1450 E.
Moroni, UT 84646-0383
Phone
(435) 851-6821
NPI assigned
Feb 6, 2014
Last updated
Feb 6, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2014

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

Authorized official

Name
Paul BaileyNPI 1497056634
Title
Owner
Phone
(435) 851-6821

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X NU Primary

Addresses

Primary practice location

21260 N. 1450 E.
Moroni, UT 84646-0383

Mailing address

21260 N. 1450 E.
Moroni, UT 84646-0383

Other identifiers 1

IdentifierTypeStateIssuer
000MedicaidUT

National Provider Directory

National Provider Directory
Tax ID family
South Pointe Youth2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1391644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391644800000",
    "number": "1699199935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21260 N. 1450 E.",
            "city": "MORONI",
            "state": "UT",
            "postal_code": "846460383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21260 N. 1450 E.",
            "city": "MORONI",
            "state": "UT",
            "postal_code": "846460383",
            "telephone_number": "435-851-6821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TREVOR HANSEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-06",
        "last_updated": "2014-02-06",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "435-851-6821"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moroni, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2014; 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.