CIRQUE LODGE INC
NPI 1437692241
Substance Abuse Rehabilitation Facility in Sundance, UT

NPI Status: Active since November 28, 2016

Contact Information

3114 E IDA'S ROAD
SUNDANCE, UT
ZIP 84604
Phone: (801) 222-9200
Fax: (801) 222-0112

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  • Organization
  • Substance Abuse Rehabilitation Facility
  • CLIA Number: 46D1082023
  • CLIA Cert. Type: Other
  • CLIA Exp. Date: 03-30-2026

About CIRQUE LODGE INC

This page provides the complete NPI Profile along with additional information for Cirque Lodge Inc, a provider established in Sundance, Utah operating as a Substance Abuse Rehabilitation Facility. The healthcare provider is registered in the NPI registry with number 1437692241 assigned on November 2016. The practitioner's primary taxonomy code is 324500000X with license number 28275 (UT). The provider is registered as an organization and their NPI record was last updated 9 years ago. The authorized official of this NPI record is Gary Fisher (Executive Director)

NPI
1437692241
Provider Name
CIRQUE LODGE INC
Entity Type
Organization
Location Address
3114 E IDA'S ROAD SUNDANCE, UT 84604
Location Phone
(801) 222-9200
Location Fax
(801) 222-0112
Mailing Address
RR 3 BOX A10 SUNDANCE, UT 84604
Mailing Phone
(801) 222-9200
Mailing Fax
(801) 222-0112
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
11-28-2016
Last Update Date
11-28-2016
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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

Substance Abuse Rehabilitation Facility

Taxonomy Code
324500000X
Type
Residential Treatment Facilities
License No.
28275
License State
UT
Taxonomy Description
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

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

GARY FISHER

Authorized Official Title
EXECUTIVE DIRECTOR
Authorized Official Phone
(801) 222-9200

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
46D1082023
Facility Type
Other
Certificate Effective Date
March 31, 2024
Certificate Expiration Date
March 30, 2026
Laboratory Director
GARY FISHER
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Cirque Lodge Inc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1437692241
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2467129428
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 4 + 6 + 7 + 1 + 2 + 9 + 4 + 2 + 8 + 24 = 69
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 69 = 11

The NPI number 1437692241 is valid because the calculated check digit 1 using the Luhn validation algorithm matches the last digit of the original NPI number.

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1437692241, enumerated in the NPI registry as an "organization" on November 28, 2016

The provider is located at 3114 E Ida's Road Sundance, Ut 84604 and the phone number is (801) 222-9200

This medical organization specializes in Substance Abuse Rehabilitation Facility with taxonomy code 324500000X

The provider's CLIA number is 46D1082023 for a "other" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..

This NPI record was last updated on November 28, 2016. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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