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NPI Code Detail

MEDICARE: PIONEER YOUTH & ADULT COMMUNITY SERVICES

MEDICARE: PIONEER YOUTH & ADULT COMMUNITY SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency16168UT
2253J00000XFoster Care Agency16167UT

General Provider Information

NPI Number : 1083932727
Entity Type Code : Organization
Provider Name (Legal Business Name) : PIONEER YOUTH & ADULT COMMUNITY SERVICES
Provider Business Mailing Address
First Line : PO BOX 651372
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84165-1372
Country : US
Telephone Number : 801-474-2500
Fax Number : 801-474-9117
Provider Business Practice Location Address
First Line : 3030 S MAIN ST STE 400
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-3578
Country : US
Telephone Number : 801-474-2500
Fax Number : 801-474-9117
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. LEIMA MUTI TUPUA
Credential :
Telephone Number : 801-474-2500
Provider Enumeration Date : 05/05/2010
Last Update Date : 05/05/2010

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Directions to “PIONEER YOUTH & ADULT COMMUNITY SERVICES ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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