DEER HOLLOW LAKESIDE LLC (NPI# 1487160875) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487160875 |
| Entity Type | Organization |
| Organization Name | DEER HOLLOW LAKESIDE LLC |
| Practice Address |
7904 S Nordic Trail Ln Brighton UT 84121-1000 |
| Mailing Address |
Po Box 1078 Draper UT 84020-1078 |
| Practice Telephone | 8016796669 |
| Practice Fax Number | 8012039216 |
| Mailing Telephone | 8016796669 |
| Mailing Fax Number | 8012039216 |
| Enumeration Date | 2017-12-20 |
| Last Update Date | 2018-02-23 |
| Authorized Official Name | TINA R ROMANO (DIRECTOR OF FINANCIAL OPERATIONS) |
| Authorized Official Telephone | 8017591734 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 324500000X | Substance Abuse Rehabilitation Facility | 53992 | UT | Residential Treatment Facilities |
| N | 324500000X | Substance Abuse Rehabilitation Facility | 53972 | UT | Residential Treatment Facilities |
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 51884 | UT | Residential Treatment Facilities |
| Street Address |
7904 S NORDIC TRAIL LN |
| City | BRIGHTON |
| State | UT |
| Zip Code | 84121-1000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134680093 | Shasta Nikita Mitchell | Registered Nurse | 7904 S Nordic Trail Ln, Brighton, UT 84121-5853 | 2019-03-25 |
| 1124508080 | Tiffany Lee Murphy | Registered Nurse | 7904 S Nordic Trail Ln, Brighton, UT 84121-5853 | 2018-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407483522 | Kaitlyn Horne | Behavior Technician | 6910 S. Highland Drive, Cottonwood Heights, UT 84121 | 2020-03-26 |
| 1952936387 | Jared Wells | Behavior Technician | 6910 S Highland Drive, Cottonwood Heights, UT 84121 | 2020-03-05 |
| 1518591874 | Slc Plastic Surgery LLC | Plastic Surgery | 6686 Highland Drive, Cottonwood Heights, UT 84121 | 2020-02-26 |
| 1093273708 | Anna O'hearon | Counselor | New Roads Behavioral Health, 2450 Fort Union Blvd, Cottonwood Heights, UT 84121 | 2019-03-12 |
| 1053883181 | Charles Keller IIi | Pediatrics | 2198 S Yvonne Rd #344, Salt Lake City, UT 84121 | 2018-12-31 |
| 1669964516 | Marissa King | Specialist | 1141 E. 3900 S. Suite 150a, Salt Lake, UT 84121 | 2018-06-05 |
| 1376044313 | Slpd Cottonwood LLC | Dentist | 7167 South Highland Drive, 200, Cottonwood Heights, UT 84121 | 2018-02-26 |
| 1700315462 | Nelson & Tillmann Family Dentistry, PC | Dentist | 5872 S. 900 E. Ste 202, Salt Lake City, UT 84121 | 2017-06-07 |
| 1912430588 | Wasatch Midwifery and Wellness, LLC | Dietitian, Registered | 6440 S Wasatch Blvd, Ste 140, Holladay, UT 84121 | 2017-04-10 |
| 1407308331 | Tina Polgar | Registered Nurse | 6244 Highland Drive, Murray, UT 84121 | 2016-10-26 |
| Find all providers in zip 84121 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508265612 | Cold Creek Wellness Center | Substance Abuse Rehabilitation Facility | 8155 S Brighton Loop Rd, Brighton, UT 84121-9779 | 2014-08-14 |
| 1952613358 | Sharon E Whitworth | Substance Abuse Rehabilitation Facility | 77 Warren St, Brighton, MA 02135-3601 | 2010-07-14 |
| 1942512470 | Christopher Walsh | Substance Abuse Rehabilitation Facility | 77 Warren St, Brighton, MA 02135-3601 | 2010-07-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063013886 | Brc Wellness LLC | Substance Abuse Rehabilitation Facility | 4911 S 900 E Ste B, Salt Lake City, UT 84117-5747 | 2020-11-06 |
| 1891307104 | Steps Recovery Center | Substance Abuse Rehabilitation Facility | 345 E 4500 S # 100-140, Murray, UT 84107-3991 | 2020-08-18 |
| 1104460666 | Active Recovery, LLC | Substance Abuse Rehabilitation Facility | 25 S Main St # 212, Centerville, UT 84014-1840 | 2019-10-28 |
| 1437709441 | Insight Recovery Cedar City, LLC | Substance Abuse Rehabilitation Facility | 1050 W Old Highway 91, Parowan, UT 84761-7725 | 2019-09-12 |
| 1316506470 | Evnsq, LLC | Substance Abuse Rehabilitation Facility | 5162 S Highland Dr, Holladay, UT 84117-7048 | 2019-06-11 |
| 1114584356 | Juniper Canyon Recovery Center for Women, LLC | Substance Abuse Rehabilitation Facility | 520 North Aspen Road, Loa, UT 84747-8474 | 2019-05-23 |
| 1750948030 | Liberty Addiction Recovery Centers LLC | Substance Abuse Rehabilitation Facility | 10458 N 6570 W, Highland, UT 84003-9311 | 2019-05-22 |
| 1235793290 | Mountain Valley Recovery LLC | Substance Abuse Rehabilitation Facility | 9431 N 400 W, Holden, UT 84636 | 2019-04-25 |
| 1346803525 | Brookstone Foundation | Substance Abuse Rehabilitation Facility | 198 N 100 E # 198n100e, St George, UT 84770-2831 | 2019-04-15 |
| 1639649684 | Sterling Recovery | Substance Abuse Rehabilitation Facility | 525 W 465 N Ste 130, Providence, UT 84332-5604 | 2018-12-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.