NPIMap

Organization Active NPI

The Phoenix Recovery Center LLC

  • Substance Abuse Rehabilitation Facility
  • Ste 500, UT
National Provider Identifier
1770828873
Registry record updated Apr 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
20020 Issued in UT
Legal business name
THE PHOENIX RECOVERY CENTER LLC
Practice address
489 W. South Jordan Parkway
Ste 500, UT 84095
Phone
(801) 438-3185
Fax
(801) 438-3184
NPI assigned
Dec 1, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2021

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

Authorized official

Name
Kristin Timmons
Title
Executive Director
Phone
(801) 438-3185

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X
Substance Abuse Rehabilitation Facility 324500000X 20020 UT Primary

Addresses

Primary practice location

489 W. South Jordan Parkway
Ste 500, UT 84095

Mailing address

11762 S State St
Suite 360
Draper, UT 84020-7155
Phone (801) 571-6798

Other practice location 1

11337 S 445 W
South Jordan, UT 84095-4027
Phone (801) 571-6798

National Provider Directory

National Provider Directory
Tax ID family
The Phoenix Recovery Counseling Center - Riverdale8 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

11762 S State St
Ste 360
Draper, UT 84020
Phone (801) 571-6364

489 W South Jordan Pkwy
Ste 500
South Jordan, UT 84095
Phone (801) 438-3185

489 W South Jordan Pkwy
Ste 400
South Jordan, UT 84095
Phone (801) 438-3185

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1354320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617580800000",
    "number": "1770828873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11762 S STATE ST",
            "address_2": "SUITE 360",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840207155",
            "telephone_number": "801-571-6798",
            "fax_number": "801-619-2016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "489 W. SOUTH JORDAN PARKWAY",
            "city": "STE 500",
            "state": "UT",
            "postal_code": "84095",
            "telephone_number": "801-438-3185",
            "fax_number": "801-438-3184"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11337 S 445 W",
            "address_purpose": "LOCATION",
            "city": "South Jordan",
            "state": "UT",
            "postal_code": "840954027",
            "country_code": "US",
            "telephone_number": "801-571-6798",
            "fax_number": "801-619-2016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE PHOENIX RECOVERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-01",
        "last_updated": "2021-04-05",
        "certification_date": "2021-03-15",
        "status": "A",
        "authorized_official_last_name": "TIMMONS",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "801-438-3185"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "UT",
            "license": "20020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2021; 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.