Awakening Behavioral Health, LLC

Primary specialty

Recovery Care Clinic/CenterTaxonomy code 261QR0800X

Legal business name

AWAKENING BEHAVIORAL HEALTH, LLC

Practice address

9160 S 300 W Ste 3
Sandy, UT 84070-2656

Phone

(801) 545-0406

NPI assigned

Dec 26, 2016

Organization subpart

Yes

Parent organization

AWAKENING BEHAVIORAL HEALTH, LLCAs reported in NPPES

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

Authorized official

Name

Kerrylynn Baca-Pelphrey

Title

Cco, Exec Dir Payor Relations

Phone

(801) 658-9646

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Tax ID family

Awakening Behavioral Health LLC3 organizations share this tax ID, including this one

Part of

Awakening Behavioral Health LLC

Other organizations with this tax ID 2

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

• Awakening Behavioral Health, LLC

  • Adult Mental Health Clinic/Center
  • St George, UT
  • NPI 1215736335
  NPD tax ID
• Awakening Behavioral Health, LLC

  dba Renaissance Ranch Bluffdale Men's Program, LLC

  • Substance Abuse Rehabilitation Facility
  • Bluffdale, UT
  • NPI 1619412046
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Awakening Behavioral Health, LLC

  • Adult Mental Health Clinic/Center
  • St George, UT
  • NPI 1215736335
  NPPES parent name

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

{
    "created_epoch": "1482710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1962947101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2973 W 13800 S",
            "city": "BLUFFDALE",
            "state": "UT",
            "postal_code": "84065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9160 S 300 W STE 3",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840702656",
            "telephone_number": "801-545-0406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AWAKENING BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AWAKENING BEHAVIORAL HEALTH, LLC",
        "enumeration_date": "2016-12-26",
        "last_updated": "2023-11-27",
        "certification_date": "2020-03-02",
        "status": "A",
        "authorized_official_last_name": "BACA-PELPHREY",
        "authorized_official_first_name": "KERRYLYNN",
        "authorized_official_title_or_position": "CCO, EXEC DIR PAYOR RELATIONS",
        "authorized_official_telephone_number": "801-658-9646"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "UT",
            "license": "37088",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "UT",
            "license": "37087",
            "primary": false
        },
        {
            "code": "261QR0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Recovery Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF UTAH HUMAN SERVICES",
            "identifier": "54650",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Sandy",
            "affiliation": "Y",
            "endpointDescription": "Direct Email",
            "affiliationName": "Renaissance Ranch Bluffdale Men's Program",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9160 S 300 W Ste 3",
            "city": "Sandy",
            "state": "UT",
            "country_code": "US",
            "postal_code": "840702656",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Recovery Care Clinic/Center in Sandy, UT
• Providers in Sandy, UT by specialty
• Recovery Care Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.