Provider Demographics
NPI:1467622142
Name:LIAHONA ACADEMY FOR YOUTH, LLC
Entity Type:Organization
Organization Name:LIAHONA ACADEMY FOR YOUTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:AH QUIN, JR.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-656-2227
Mailing Address - Street 1:144 E 2580 SOUTH CIR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7493
Mailing Address - Country:US
Mailing Address - Phone:435-656-2227
Mailing Address - Fax:435-626-2228
Practice Address - Street 1:385 WEST 600 NORTH
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-5025
Practice Address - Country:US
Practice Address - Phone:435-635-0740
Practice Address - Fax:435-656-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10217322D00000X
UT12758323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT15025OtherOUTPATIENT TREATMENT CENTER
UT10217/13569OtherRESIDENTIAL TREATMENT CENTER
UT14981OtherDAY TREATMENT CENTER