Provider Demographics
NPI:1568733418
Name:UTAH YOUNG FARMER APPRENTICESHIP REHAB AND MENTORING PROGRAM, P.C.
Entity Type:Organization
Organization Name:UTAH YOUNG FARMER APPRENTICESHIP REHAB AND MENTORING PROGRAM, P.C.
Other - Org Name:CROSSROADS PROFESSIONAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOBBY
Authorized Official - Suffix:
Authorized Official - Credentials:CSW
Authorized Official - Phone:435-512-3888
Mailing Address - Street 1:276 S 400 W
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:UT
Mailing Address - Zip Code:84647-1529
Mailing Address - Country:US
Mailing Address - Phone:435-512-3888
Mailing Address - Fax:
Practice Address - Street 1:276 S 400 W
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:UT
Practice Address - Zip Code:84647-1529
Practice Address - Country:US
Practice Address - Phone:435-512-3888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6111891-3502251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health