CIRQUE LODGE INC. (NPI# 1912108242) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912108242 |
| Entity Type | Organization |
| Organization Name | CIRQUE LODGE INC. |
| Practice Address |
777 N Palisades Dr Orem UT 84097-4341 |
| Practice Telephone | 8012229200 |
| Practice Fax Number | 8012220112 |
| Mailing Telephone | 8012229200 |
| Mailing Fax Number | 8012220112 |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2016-11-26 |
| Authorized Official Name | GARY FISHER (DIRECTOR OF OPERATIONS) |
| Authorized Official Telephone | 8012229200 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 12370 | UT | Residential Treatment Facilities |
| Street Address |
777 N PALISADES DR |
| City | OREM |
| State | UT |
| Zip Code | 84097-4341 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679869614 | John Ryan Watkins | General Practice | 777 N Palisades Dr, Orem, UT 84097-4341 | 2011-06-28 |
| 1881903250 | Betty Howell Mcelroy | Psychiatry & Neurology | 777 N Palisades Dr, Orem, UT 84097-4341 | 2010-10-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700392735 | Scott Harris | Chiropractor | 1425 S State St, Orem, UT 84097 | 2017-12-28 |
| 1457870990 | Summit Laboratory Services | Pathology | 1480 East 820 North, Orem, UT 84097 | 2017-09-15 |
| 1144759275 | White Smiles Family Dentistry | Clinic/Center | 594 E 800 S Suite G, Orem, UT 84097 | 2017-06-12 |
| 1801322367 | Mallory Hendrickson | Assistant Behavior Analyst | 744 E 1650 S, Orem, UT 84097 | 2017-05-03 |
| 1841648664 | National Vision, Inc. | Technician/Technologist | 545 E University Pkwy, Ste 103, Orem, UT 84097 | 2016-06-02 |
| 1538435045 | Wasatch Mental Health | Case Management | 1127 N 1450 E, Orem, UT 84097 | 2012-03-29 |
| 1366720104 | Deseret Counseling Inc | Social Worker | 1325 South 800 East, Suite 115 Room 115 B, Orem, UT 84097 | 2011-07-27 |
| 1598056053 | Uhs of Provo Canyon Inc | Psychiatric Residential Treatment Facility | 1350 E 750 North, Orem, UT 84097 | 2011-05-02 |
| 1659677219 | Francisco Xavier Ampuero | Counselor | 1015 So. State Street, Bsmt. Office, Orem, UT 84097 | 2011-01-31 |
| 1275835449 | Pursonna Tuiletufuga | Counselor | 1160 South Main Street, Suite 180a, Orem, UT 84097 | 2010-11-22 |
| Find all providers in zip 84097 | ||||
| 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 |
|---|---|---|---|---|
| 1710344585 | Renaissance Ranch Outpatient Treatment | Substance Abuse Rehabilitation Facility | 591 W 800 N Ste 202, Orem, UT 84057-3762 | 2016-01-25 |
| 1093043697 | New Roads Treatment Centers | Substance Abuse Rehabilitation Facility | 1365 South 1250 West, Suite 101, Orem, UT 84058 | 2009-11-20 |
| 1710129663 | Nexstep LLC | Substance Abuse Rehabilitation Facility | 353 E 1200 S, Orem, UT 84058-6904 | 2009-03-24 |
| 1518324383 | Renaissance Ranch Outpatient Treatment | Substance Abuse Rehabilitation Facility | 265 W Center St, Orem, UT 84057-4611 | 2016-01-25 |
| 1427445980 | Steps Recovery Center | Substance Abuse Rehabilitation Facility | 901 S Orem Blvd, Orem, UT 84058-5011 | 2015-04-22 |
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| 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 |
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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.