Provider Demographics
NPI:1083767297
Name:YOUTH CARE OF UTAH, INC.
Entity Type:Organization
Organization Name:YOUTH CARE OF UTAH, INC.
Other - Org Name:PINE RIDGE ACADEMY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PACKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-572-6989
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-0909
Mailing Address - Country:US
Mailing Address - Phone:801-572-6989
Mailing Address - Fax:801-572-8220
Practice Address - Street 1:12595 MINUTEMAN DR
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9541
Practice Address - Country:US
Practice Address - Phone:801-572-6989
Practice Address - Fax:801-572-8220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12293, 12294, 12295323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility