Healthcare Provider Details

I. General information

NPI: 1376725515
Provider Name (Legal Business Name): PINNACLE YOUTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 S MAIN ST SUITE 201
CEDAR CITY UT
84720-3475
US

IV. Provider business mailing address

5890 SHANGRI LN
HOLLADAY UT
84121-1457
US

V. Phone/Fax

Practice location:
  • Phone: 435-868-9009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number13366
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TERENCE M KEEHAN
Title or Position: TREASURER
Credential:
Phone: 801-755-1977