1235421306 NPI number — YOUTHTRACK, INC.

Table of content: (NPI 1235421306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235421306 NPI number — YOUTHTRACK, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUTHTRACK, INC.
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:
RESCARE HOMECARE OR RES-CARE INC.
Provider Other Organization Name Type Code:
3
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:
1235421306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 W BEHREND DR STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85027-4403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-434-8443
Provider Business Mailing Address Fax Number:
623-434-8561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 S RIVER RD
Provider Second Line Business Practice Location Address:
SUITE A210-D
Provider Business Practice Location Address City Name:
SAINT GEORGE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84790-5507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-652-4495
Provider Business Practice Location Address Fax Number:
435-688-8301
Provider Enumeration Date:
05/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SQUIRES
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
BRANCH MANAGER - UTAH
Authorized Official Telephone Number:
801-288-4100

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  2011-HHA-95019 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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