CREATORS LEGACY HOMES LLC — NPI 1770404279 (Licensed & Credentialed Peer Specialist in MIDVALE, UT)

CMS-1500 Box 24J / 33a • NPI

1770404279

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

175T00000X

Licensed & Credentialed Peer Specialist

Box 32 Service Location & ZIP+4

332 W HARVARD DR, MIDVALE, UT, 84047-7582

✓ 9-Digit EDI 837 ZIP+4 (84047-7582)

Practice Phone & Referral Fax

(801) 946-2323

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1770404279 (CREATORS LEGACY HOMES LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1770404279` (NPI-2 Organization / Facility)
Provider / Legal Name	CREATORS LEGACY HOMES LLC
Plain-English Specialty	Licensed & Credentialed Peer Specialist NUCC Code: `175T00000X` (Peer Specialist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	332 W HARVARD DR, MIDVALE, UT, 84047-7582
Practice Telephone / Fax	Tel: (801) 946-2323
Administrative Mailing Address	636 S 40 E, SALEM, UT, 84653-9530
Enumeration & Last Sync	Enumerated: 2026-07-22 \| CMS Record Updated: 2026-07-22
Authorized Official	MATTHEW VICARIO (Clinical Director)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

332 W HARVARD DR, MIDVALE, UT, 84047-7582

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Plain-English Taxonomy & CMS Crosswalk (175T00000X)

What Does Taxonomy Code 175T00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 175T00000X translates to:
"Licensed & Credentialed Peer Specialist"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Peer Specialist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (CREATORS LEGACY HOMES LLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`101YA0400X` — Counselor, Addiction (Substance Use Disorder) Plain English: Licensed & Credentialed Counselor, Addiction (Substance Use Disorder)	State: N/A \| License: `Verified` \| Primary: Secondary
`101YM0800X` — Counselor, Mental Health Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor	State: N/A \| License: `Verified` \| Primary: Secondary
`171M00000X` — Case Manager/Care Coordinator Plain English: Licensed & Credentialed Case Manager/Care Coordinator	State: N/A \| License: `Verified` \| Primary: Secondary
`175T00000X` — Peer Specialist Plain English: Licensed & Credentialed Peer Specialist	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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CREATORS LEGACY HOMES LLC (NPI #1770404279)