Healthcare Provider Details

I. General information

NPI: 1831229731
Provider Name (Legal Business Name): UTAH YOUTH VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 HIGHLAND DR
SALT LAKE CITY UT
84121-1359
US

IV. Provider business mailing address

5800 HIGHLAND DR
SALT LAKE CITY UT
84121-1359
US

V. Phone/Fax

Practice location:
  • Phone: 801-272-9980
  • Fax: 801-272-9976
Mailing address:
  • Phone: 801-272-9980
  • Fax: 801-272-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number12081
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number12080
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number12070-12073,12082-83
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number12124-25,12489
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12081
License Number StateUT

VIII. Authorized Official

Name: ERIC BJORKLUND
Title or Position: PRESIDENT
Credential:
Phone: 801-272-9980