Utah Advocacy Network

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

UTAH ADVOCACY NETWORK

Practice address

2075 South Bluff Road
Syracuse, UT 84075-9214

Phone

(801) 776-1380

Fax

(801) 784-4900

NPI assigned

Feb 11, 2015

Organization subpart

No

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

Authorized official

Name

Mr. David B. Andreasen, QIDP DIRECTOR

Title

Owner

Phone

(801) 643-2866

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Syracuse Supported Living (UAN-SSL) Other name

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

{
    "created_epoch": "1423612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493683200000",
    "number": "1952792004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2075 SOUTH BLUFF ROAD",
            "city": "SYRACUSE",
            "state": "UT",
            "postal_code": "840759214",
            "telephone_number": "801-776-1380",
            "fax_number": "801-784-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2075 SOUTH BLUFF ROAD",
            "city": "SYRACUSE",
            "state": "UT",
            "postal_code": "840759214",
            "telephone_number": "801-776-1380",
            "fax_number": "801-784-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UTAH ADVOCACY NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-11",
        "last_updated": "2017-05-02",
        "status": "A",
        "authorized_official_last_name": "ANDREASEN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-643-2866",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "QIDP DIRECTOR"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": "UT",
            "license": "189610-3102-20170122",
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5107101201",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHIN-TRADING PARTNER NUMBER",
            "identifier": "HT007851-001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Syracuse Supported Living (UAN-SSL)",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Syracuse, UT
• Providers in Syracuse, UT by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2017; 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.