Active NPI
Providential Bba Operating LP
- Long Term Care Hospital
- Bountiful, UT
National Provider Identifier
1982647103
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Hospital
- License
- 2016HOSP207
- Legal business name
- PROVIDENTIAL BBA OPERATING LP
- Practice address
- 485 E 500 S
Bountiful, UT 84010-3801 - Phone
- (801) 295-2361
- Fax
- (801) 295-1398
- NPI assigned
- Jun 14, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- David A. Bland
- Title
- Ceo
- Phone
- (801) 397-8101
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chronic Disease Hospital | 281P00000X | 2005HOSP207 | UT | |
| Long Term Care Hospital | 282E00000X | 2016HOSP207 | UT | Primary |
Addresses
Primary practice location
485 E 500 S
Bountiful, UT 84010-3801
Mailing address
401 South 400 East
Bountiful, UT 84010
Phone (801) 295-2361
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982647103 | Medicaid | UT |
Other names 2
- Specialty Hospital of Utah
- Western Peaks Specialty Hospital
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1592784000000",
"number": "1982647103",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 SOUTH 400 EAST",
"city": "BOUNTIFUL",
"state": "UT",
"postal_code": "84010",
"telephone_number": "801-295-2361",
"fax_number": "801-295-1398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "485 E 500 S",
"city": "BOUNTIFUL",
"state": "UT",
"postal_code": "840103801",
"telephone_number": "801-295-2361",
"fax_number": "801-295-1398"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PROVIDENTIAL BBA OPERATING LP",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-14",
"last_updated": "2020-06-22",
"certification_date": "2020-06-22",
"status": "A",
"authorized_official_last_name": "BLAND",
"authorized_official_first_name": "DAVID",
"authorized_official_middle_name": "A.",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "801-397-8101"
},
"taxonomies": [
{
"code": "281P00000X",
"taxonomy_group": "",
"desc": "Chronic Disease Hospital",
"state": "UT",
"license": "2005HOSP207",
"primary": false
},
{
"code": "282E00000X",
"taxonomy_group": "",
"desc": "Long Term Care Hospital",
"state": "UT",
"license": "2016HOSP207",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1982647103",
"state": "UT"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Specialty Hospital of Utah",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Western Peaks Specialty Hospital",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Western Peaks Specialty Hospital",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Specialty Hospital of Utah",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Bountiful, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 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.