Provider Demographics
NPI:1558670612
Name:PIUTE YOUTH DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:PIUTE YOUTH DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLCHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-201-9215
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:MARYSVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84750-0133
Mailing Address - Country:US
Mailing Address - Phone:435-201-9215
Mailing Address - Fax:435-527-8883
Practice Address - Street 1:8510 SOUTH TEN MILE ROAD
Practice Address - Street 2:
Practice Address - City:MARYSVALE
Practice Address - State:UT
Practice Address - Zip Code:84750
Practice Address - Country:US
Practice Address - Phone:435-201-9215
Practice Address - Fax:435-527-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency