Healthcare Provider Details

I. General information

NPI: 1598149163
Provider Name (Legal Business Name): YOUTH HEALTH ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6484 N 2300 W
CEDAR CITY UT
84721-7102
US

IV. Provider business mailing address

520 N MARKET PLACE DR STE 100
CENTERVILLE UT
84014-4902
US

V. Phone/Fax

Practice location:
  • Phone: 435-867-4876
  • Fax: 435-867-4893
Mailing address:
  • Phone: 801-330-8845
  • Fax: 801-683-8962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number12085
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number12085
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number12085
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number12085
License Number StateUT

VII. Legacy identifiers

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

# 1
Identifier108194100
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name: SHAYNE MILLER
Title or Position: CFO
Credential:
Phone: 801-330-8845