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General NPI Number Information
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NPI Number | 1235421306
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Entity Type | Organization
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Legal Business Name | YOUTHTRACK, INC.
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Dates
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Enumeration Date | 05/09/2011
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 720 S RIVER RD SUITE A210-D
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City | SAINT GEORGE
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State | UT
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Zip | 84790-5507
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Country | US
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Telephone | 435-652-4495
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Fax | 435-688-8301
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Provider Business Mailing Address
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Address Line | 950 W BEHREND DR STE 1
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City | PHOENIX
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State | AZ
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Zip | 85027-4403
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Country | US
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Telephone | 623-434-8443
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Fax | 623-434-8561
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Authorized Official
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Title or Position | BRANCH MANAGER - UTAH
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Name | MRS. ELIZABETH SQUIRES
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Credential |
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Telephone | 801-288-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 2011-HHA-95019
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License Number State | UT
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