Provider Demographics
NPI:1306199120
Name:HERITAGE YOUTH SERVICES
Entity Type:Organization
Organization Name:HERITAGE YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-798-9077
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-0117
Mailing Address - Country:US
Mailing Address - Phone:801-798-9077
Mailing Address - Fax:801-798-8949
Practice Address - Street 1:31 E 1600 N
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1011
Practice Address - Country:US
Practice Address - Phone:801-798-9077
Practice Address - Fax:801-798-8949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children