MEDICARE: 4 THE YOUTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253J00000X	Foster Care Agency	16013	UT
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1609108075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	4 THE YOUTH

Provider Business Mailing Address
First Line	:	1342 W STATE RD
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-5023
Country	:	US
Telephone Number	:	801-785-8870
Fax Number	:	801-785-9454

Provider Business Practice Location Address
First Line	:	1342 W STATE RD
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-5023
Country	:	US
Telephone Number	:	801-785-8870
Fax Number	:	801-785-9454

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MRS. STEPHANIE GROVER
Credential	:	M.ED
Telephone Number	:	801-785-8870

Provider Enumeration Date	:	02/09/2010
Last Update Date	:	02/01/2022

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Directions to “4 THE YOUTH ” Practice Location

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