NPIMap

Organization Active NPI

Wasatch Youth Support Systems

  • Substance Use Disorder Rehabilitation Clinic/Center
  • West Valley City, UT
National Provider Identifier
1740583079
Registry record updated Dec 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
293074-2501 Issued in UT
Legal business name
WASATCH YOUTH SUPPORT SYSTEMS
Practice address
3392 W 3500 S
West Valley City, UT 84119-2630
Phone
(801) 969-3307
Fax
(801) 964-8898
NPI assigned
Dec 8, 2010
Last updated
Dec 8, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2010

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

Authorized official

Name
Dr. James Russell Marchel, PH.D.
Title
Agency Administrator
Phone
(801) 969-3307

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 293074-2501 UT Primary

Addresses

Primary practice location

3392 W 3500 S
West Valley City, UT 84119-2630

Mailing address

3392 W 3500 S
West Valley City, UT 84119-2630
Phone (801) 969-3307

Other identifiers 1

IdentifierTypeStateIssuer
261QR0405XMedicaidUT

National Provider Directory

National Provider Directory
Tax ID family
Wasatch Youth Support Systems8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

3392 W 3500 S
West Valley City, UT 84119
Phone (801) 969-3307

NPI Registry JSON

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

{
    "created_epoch": "1291766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291766400000",
    "number": "1740583079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3392 W 3500 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841192630",
            "telephone_number": "801-969-3307",
            "fax_number": "801-964-8898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3392 W 3500 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841192630",
            "telephone_number": "801-969-3307",
            "fax_number": "801-964-8898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASATCH YOUTH SUPPORT SYSTEMS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-08",
        "last_updated": "2010-12-08",
        "status": "A",
        "authorized_official_last_name": "MARCHEL",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "AGENCY ADMINISTRATOR",
        "authorized_official_telephone_number": "801-969-3307",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "UT",
            "license": "293074-2501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "261QR0405X",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Dec 8, 2010; 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.