Healthcare Provider Details

I. General information

NPI: 1659708923
Provider Name (Legal Business Name): YOUTH HEALTH ASSACIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5887 S WEBER DR
RIVERDALE UT
84405-9746
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 801-773-9149
  • Fax: 801-773-9152
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