Healthcare Provider Details

I. General information

NPI: 1609108075
Provider Name (Legal Business Name): 4 THE YOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 W STATE RD
PLEASANT GROVE UT
84062-5023
US

IV. Provider business mailing address

1342 W STATE RD
PLEASANT GROVE UT
84062-5023
US

V. Phone/Fax

Practice location:
  • Phone: 801-785-8870
  • Fax: 801-785-9454
Mailing address:
  • Phone: 801-785-8870
  • Fax: 801-785-9454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number16013
License Number StateUT

VIII. Authorized Official

Name: MRS. STEPHANIE GROVER
Title or Position: PROGRAM DIRECTOR
Credential: M.ED
Phone: 801-785-8870