Healthcare Provider Details

I. General information

NPI: 1164766077
Provider Name (Legal Business Name): APEX YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 S 800 W
BRIGHAM CITY UT
84302-2400
US

IV. Provider business mailing address

329 S 200 W
BRIGHAM CITY UT
84302-2513
US

V. Phone/Fax

Practice location:
  • Phone: 435-734-9511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: BRET JACKMAN
Title or Position: OWNER
Credential:
Phone: 435-734-9511