Provider Demographics
NPI:1568883387
Name:STRENGTHENING TEENS, LLC
Entity Type:Organization
Organization Name:STRENGTHENING TEENS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LANDON
Authorized Official - Suffix:
Authorized Official - Credentials:CTRS, TRS
Authorized Official - Phone:801-960-3040
Mailing Address - Street 1:165 N 1330 W STE A1
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-5111
Mailing Address - Country:US
Mailing Address - Phone:801-960-3040
Mailing Address - Fax:
Practice Address - Street 1:165 N 1330 W STE A1
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-5116
Practice Address - Country:US
Practice Address - Phone:801-960-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2662, 3426253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1295706893Medicaid
UT1386826030Medicaid
UT1801194857Medicaid
UT1881992212Medicaid