Healthcare Provider Details

I. General information

NPI: 1407875750
Provider Name (Legal Business Name): YOUTH HEALTH ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 801-330-8845
  • Fax: 801-683-8962
Mailing address:
  • Phone: 801-330-8845
  • Fax: 801-683-8962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SHAYNE MILLER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 801-330-8845