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Contact Information

EVOLUTION ACADEMY OF UTAH LLC
1144 W 3300 S
SALT LAKE CITY, UT84119-7175
 Phone: 801-433-2900
 Fax: 801-433-2999
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychiatric Residential Treatment Facility

323P00000X
Indicates primary specialty

NPI Profile & details for EVOLUTION ACADEMY OF UTAH LLC

NPI Number 1558432849
LBN Legal business name EVOLUTION ACADEMY OF UTAH LLC
Authorized official JAMES BAILEY - (C.E.O.)
Entity Organization
Organization subpart 1 No
Enumeration date 11/10/2006
Last updated 08/22/2020 - About 6 years ago
Identifiers
UT License # 11353
AK Medicaid HS339PI
MT Medicaid 4103783
NM Medicaid 55880347
SD Medicaid 5168120
VA Medicaid 4766
WV Medicaid 3810005990
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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