BLUE HILLS RESIDENTIAL TREATMENT (NPI# 1720465727) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720465727 |
| Entity Type | Organization |
| Organization Name | BLUE HILLS RESIDENTIAL TREATMENT |
| Practice Address |
21360 N 1450 E Moroni UT 84646-0461 |
| Mailing Address |
21360 N 1450 E Po Box 461 Moroni UT 84646-0461 |
| Practice Telephone | 4354455200 |
| Practice Fax Number | 4354455201 |
| Mailing Telephone | 4354455200 |
| Mailing Fax Number | 4354455201 |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2015-04-29 |
| Authorized Official Name | KEVIN R BAILEY (CLINICIAN) |
| Authorized Official Telephone | 4354455200 |
| Authorized Official Credential | ACMHC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | UT | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | 1235458555 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336523695 | Blue Hills Residential Treatment | Substance Abuse Rehabilitation Facility | 2860 East 19500 North, Moroni, UT 84646-0461 | 2015-07-16 |
| 1770960411 | Blue Hills Residential Treatment | Substance Abuse Rehabilitation Facility | 21360 N 1450 E, Moroni, UT 84646-0461 | 2015-05-01 |
| Street Address |
21360 N 1450 E |
| City | MORONI |
| State | UT |
| Zip Code | 84646-0461 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124328349 | Lance Irons | Counselor | 21360 N 1450 E, Moroni, UT 84646-0383 | 2010-10-22 |
| 1114448362 | Amy Ruth Brown | Counselor | 21360 N 1450 E, Moroni, UT 84646-0461 | 2017-06-28 |
| 1508386608 | Katie Cranford | Counselor | 21360 N 1450 E, Moroni, UT 84646-0461 | 2017-06-21 |
| 1366978827 | Jake Paxman | Counselor | 21360 N 1450 E, Moroni, UT 84646-0461 | 2017-05-03 |
| 1437685906 | Erick Espinoza | Counselor | 21360 N 1450 E, Moroni, UT 84646-0461 | 2017-05-03 |
| 1902354335 | Melyn Lund | Community Health Worker | 21360 N 1450 E, Moroni, UT 84646-0461 | 2016-09-14 |
| 1518319102 | Aubree Bailey | Community Health Worker | 21360 N 1450 E, Moroni, UT 84646-0461 | 2016-07-07 |
| 1699120279 | Rocky Dettamanti | Counselor | 21360 N 1450 E, Moroni, UT 84646-0461 | 2016-05-02 |
| 1407201072 | Alicia Hill | Counselor | 21360 N 1450 E, Moroni, UT 84646-0461 | 2016-05-02 |
| 1417301011 | Jenessa Tuai | Counselor | 21360 N 1450 E, Moroni, UT 84646-0461 | 2016-04-20 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942727029 | Doug Lloyd Hopes | Counselor | 21630 North 1450 East, Morona, UT 84646 | 2017-08-29 |
| 1881002061 | Compass Academy Transitional Services LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4800 E 17160 N, Moroni, UT 84646 | 2014-07-31 |
| 1932534260 | Matthew Truman Johnson | Substance Abuse Rehabilitation Facility | 2860 E 19500 N, Moroni, UT 84646 | 2013-09-05 |
| 1457611766 | Samuel Paul Wilkey | Substance Abuse Rehabilitation Facility | 21360 N 1450e, Moroni, UT 84646 | 2012-05-21 |
| 1275828949 | Robert Duane Simonson | Social Worker | 4800 East 17160 North, Moroni, UT 84646 | 2011-06-10 |
| 1386950392 | Josh Wilkey | Community Health Worker | 4800 E. 17160 N, Moroni, UT 84646 | 2010-08-27 |
| 1891007886 | Compass Academy | Residential Treatment Facility, Emotionally Disturbed Children | 4800 E. 17160 N., Moroni, UT 84646 | 2010-07-08 |
| 1518906320 | Eileen Keenan Jackson | Family Medicine | 51 E Main St., Moroni, UT 84646 | 2006-06-06 |
| 1225537707 | Jessica Pay | Counselor | 2860 East 19500 North, Moroni, UT 84646 | 2018-02-09 |
| 1134628613 | Todd Pay | Counselor | 2860 East 19500 North, Moroni, UT 84646 | 2018-02-09 |
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| 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 |
|---|---|---|---|---|
| 1336556638 | Bryan Holder | Substance Abuse Rehabilitation Facility | 21360 N 1460 E, Moroni, UT 84646-0461 | 2014-07-18 |
| 1932534260 | Matthew Truman Johnson | Substance Abuse Rehabilitation Facility | 2860 E 19500 N, Moroni, UT 84646 | 2013-09-05 |
| 1457611766 | Samuel Paul Wilkey | Substance Abuse Rehabilitation Facility | 21360 N 1450e, Moroni, UT 84646 | 2012-05-21 |
| 1235458555 | Lighthouse Ranch LLC | Substance Abuse Rehabilitation Facility | 21360 North 1450 East, Moroni, UT 84646-0461 | 2010-05-26 |
| 1447579115 | Lighthouse Academy LLC | Substance Abuse Rehabilitation Facility | 21260 N. 1450 E., Moroni, UT 84646-0383 | 2010-05-20 |
| 1316314081 | Ethan Colburn | Substance Abuse Rehabilitation Facility | 21360 N 1450 E, Moroni, UT 84646-0461 | 2015-08-28 |
| 1336523695 | Blue Hills Residential Treatment | Substance Abuse Rehabilitation Facility | 2860 East 19500 North, Moroni, UT 84646-0461 | 2015-07-16 |
| 1770960411 | Blue Hills Residential Treatment | Substance Abuse Rehabilitation Facility | 21360 N 1450 E, Moroni, UT 84646-0461 | 2015-05-01 |
| 1629497458 | James Beasley | Substance Abuse Rehabilitation Facility | 21360 N 1450 E, Moroni, UT 84646 | 2014-04-09 |
| 1932460102 | Bryant Davis | Substance Abuse Rehabilitation Facility | 21360 North 1450 East, Moroni, UT 84646 | 2012-06-05 |
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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.