Basic Information
| Provider Information | |||||||||
| NPI: | 1982947347 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAVA HEIGHTS ACADEMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 747 E SAINT GEORGE BLVD | ||||||||
| Address2: | |||||||||
| City: | SAINT GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847703035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356736111 | ||||||||
| FaxNumber: | 4356730994 | ||||||||
| Practice Location | |||||||||
| Address1: | 730 E SPRING DR | ||||||||
| Address2: | |||||||||
| City: | TOQUERVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664528772 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2013 | ||||||||
| LastUpdateDate: | 06/24/2015 | ||||||||
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| AuthorizedOfficialLastName: | PACE | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4356736111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MA ED, MC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 323P00000X | 20523 | UT | N | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | 3245S0500X | 20523 | UT | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children | 322D00000X | 20523 | UT | Y | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
No ID Information.