MAGELLAN ACADEMY, INC
NPI 1053706358
Residential Treatment Facility, Emotionally Disturbed Children in Spanish Fork, UT

Q: What is the provider's specialty?

The provider's specialty is Residential Treatment Facility, Emotionally Disturbed Children with taxonomy code 322D00000X.

Active since April 02, 2015

704 N STATE ROAD 51, SPANISH FORK, UT 84660(801) 794-0318(801) 794-9514 Get Directions Write a Review

NPPES record last updated: April 2, 2015. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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NPI Profile Information
Primary Taxonomy
Authorized Official
Other Providers Same Location
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Organization
Residential Treatment Facility, Emotiona...

About MAGELLAN ACADEMY, INC

This page provides the complete NPI Profile along with additional information for Magellan Academy, Inc, a provider established in Spanish Fork, Utah operating as a Residential Treatment Facility, Emotionally Disturbed Children. The healthcare provider is registered in the NPI registry with number 1053706358 assigned on April 2015. The practitioner's primary taxonomy code is 322D00000X. The provider is registered as an organization and their NPI record was last updated 11 years ago. The authorized official of this NPI record is Dr. Paul Wiederhold Ph.d. (Executive Director)

NPI: 1053706358 Verify this NPI
Provider Name: MAGELLAN ACADEMY, INC
Entity Type: Organization
Location Address: 704 N STATE ROAD 51 SPANISH FORK, UT 84660
Location Phone: (801) 794-0318
Location Fax: (801) 794-9514
Mailing Address: 704 N STATE ROAD 51 SPANISH FORK, UT 84660
Mailing Phone: (801) 794-0318
Mailing Fax: (801) 794-9514
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 04-02-2015
Last Update Date: 04-02-2015
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Residential Treatment Facility, Emotionally Disturbed Children
Taxonomy Code: 322D00000X
Type: Residential Treatment Facilities
License State: UT
Taxonomy Description: A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: DR. PAUL WIEDERHOLD PH.D.
Authorized Official Title: EXECUTIVE DIRECTOR
Authorized Official Phone: (801) 794-0318