Provider Demographics
NPI:1245799717
Name:UTAH VALLEY YOUTH SERVICES
Entity Type:Organization
Organization Name:UTAH VALLEY YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-310-9692
Mailing Address - Street 1:195 E 840 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5016
Mailing Address - Country:US
Mailing Address - Phone:801-226-7696
Mailing Address - Fax:
Practice Address - Street 1:195 E 840 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5016
Practice Address - Country:US
Practice Address - Phone:801-226-7696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency