1134435464 NPI number — UTAH YOUTH VILLAGE

Table of content: (NPI 1134435464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134435464 NPI number — UTAH YOUTH VILLAGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UTAH YOUTH VILLAGE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTH KEARNS HOME
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134435464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5800 HIGHLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84121-1359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-272-9980
Provider Business Mailing Address Fax Number:
801-272-9976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5934 S 4800 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEARNS
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84118-6061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-967-6325
Provider Business Practice Location Address Fax Number:
801-967-9890
Provider Enumeration Date:
08/24/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BJORKLAND
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
801-631-6921

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)