Healthcare Provider Details

I. General information

NPI: 1255699831
Provider Name (Legal Business Name): YOUTH HEALTH ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 E 450 S
CLEARFIELD UT
84015-1736
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 801-779-2253
  • Fax:
Mailing address:
  • Phone: 801-330-8845
  • Fax: 801-683-8962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

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