Healthcare Provider Details

I. General information

NPI: 1124211123
Provider Name (Legal Business Name): LOST AND FOUND YOUTH ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 WEST 300 SOUTH
MILFORD UT
84751-0000
US

IV. Provider business mailing address

PO BOX 800
MILFORD UT
84751-0800
US

V. Phone/Fax

Practice location:
  • Phone: 435-387-2223
  • Fax: 435-387-2224
Mailing address:
  • Phone: 435-387-2223
  • Fax: 435-387-2224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number12777
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL R LUKE
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 435-387-2223