Provider Demographics
NPI:1962949966
Name:SPIRIT MOUNTAIN BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:SPIRIT MOUNTAIN BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:FARNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-805-5231
Mailing Address - Street 1:5145 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-3693
Mailing Address - Country:US
Mailing Address - Phone:801-336-0658
Mailing Address - Fax:801-752-1717
Practice Address - Street 1:5145 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-3693
Practice Address - Country:US
Practice Address - Phone:801-336-0658
Practice Address - Fax:801-752-1717
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPIRIT MOUNTAIN RECOVERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT38905273Y00000X
UT35937276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No273Y00000XHospital UnitsRehabilitation Unit