NPIMap

Organization Active NPI

San Juan Mental Health-Substance Abuse SSD

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Blanding, UT
National Provider Identifier
1790898526
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
11054 Issued in UT
Legal business name
SAN JUAN MENTAL HEALTH-SUBSTANCE ABUSE SSD
Practice address
356 S Main St
Blanding, UT 84511-3830
Phone
(435) 678-2992
Fax
(435) 678-3116
NPI assigned
Aug 16, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dan S. Rogers, LCSW
Title
Executive Director
Phone
(435) 678-2992

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 11054 UT Primary

Addresses

Primary practice location

356 S Main St
Blanding, UT 84511-3830

Mailing address

356 S Main St
Blanding, UT 84511-3830
Phone (435) 678-2992

Other identifiers 1

IdentifierTypeStateIssuer
876000546138MedicaidUT

National Provider Directory

National Provider Directory
Tax ID family
San Juan Counseling2 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.

Locations

356 S Main St
Blanding, UT 84511
Phone (435) 678-2992

Practitioners & affiliated clinicians

Practitioners 53

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.

View all 53

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790898526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "356 S MAIN ST",
            "city": "BLANDING",
            "state": "UT",
            "postal_code": "845113830",
            "telephone_number": "435-678-2992",
            "fax_number": "435-678-3116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "356 S MAIN ST",
            "city": "BLANDING",
            "state": "UT",
            "postal_code": "845113830",
            "telephone_number": "435-678-2992",
            "fax_number": "435-678-3116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JUAN MENTAL HEALTH-SUBSTANCE ABUSE SSD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "DAN",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "435-678-2992",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "UT",
            "license": "11054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "876000546138",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blanding, UT

Sources for this page

  • 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.