Organization · Type 2 NPI

DDMS of Utah No.2

Intellectual and/or Developmental Disabilities Residential Treatment Facility · West Valley City, UT

NPI number 1558730218 Active

Practice location

4028 S 4800 W
West Valley City, UT 84120-4537

Fax (801) 968-8135

Specialties and licenses

Taxonomy	Code	License
Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary	320600000X	2015-SHCF-101 (UT)

Intellectual and/or Developmental Disabilities Residential Treatment Facility: A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.

2 other providers at this address

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NPI record

NPI: 1558730218
Entity type: Organization (Type 2)
Issued: Sep 23, 2015
Last updated: Jun 8, 2023
Status: Active

Other names

<unavail>
West Side Center · doing business as
West Side Center · doing business as

Authorized official

Misti Ann Buck, D.O./ADMINISTRATOR
Director of Operations
(801) 763-9299

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1558730218

DDMS of Utah No.2's National Provider Identifier is 1558730218, issued on Sep 23, 2015. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Residential Treatment Facility (320600000X), and the practice location is in West Valley City, UT. The record was last updated on Jun 8, 2023.