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General NPI Number Information
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NPI Number | 1750634382
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Entity Type | Organization
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Legal Business Name | YOUTH FOUNDATIONS
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 150 N STATE ST
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City | LA VERKIN
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State | UT
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Zip | 84745-5503
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Country | US
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Telephone | 435-635-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 150 N STATE ST
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City | LA VERKIN
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State | UT
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Zip | 84745-5503
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JADE ROBINSON
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Credential |
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Telephone | 702-219-4749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 19974
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License Number State | UT
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