Provider Demographics
NPI:1609108075
Name:4 THE YOUTH
Entity Type:Organization
Organization Name:4 THE YOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:801-785-8870
Mailing Address - Street 1:1342 W STATE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-5023
Mailing Address - Country:US
Mailing Address - Phone:801-785-8870
Mailing Address - Fax:801-785-9454
Practice Address - Street 1:1342 W STATE RD
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-5023
Practice Address - Country:US
Practice Address - Phone:801-785-8870
Practice Address - Fax:801-785-9454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
UT16013253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No253J00000XAgenciesFoster Care AgencyGroup - Single Specialty