Provider Demographics
NPI:1669857629
Name:YOUTH HEALTH ASSOCIATES, INC.
Entity Type:Organization
Organization Name:YOUTH HEALTH ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-330-8845
Mailing Address - Street 1:520 N MARKET PLACE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-4902
Mailing Address - Country:US
Mailing Address - Phone:801-330-8845
Mailing Address - Fax:801-683-8962
Practice Address - Street 1:446 E 450 S
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1736
Practice Address - Country:US
Practice Address - Phone:801-779-2253
Practice Address - Fax:801-525-6415
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUTH HEALTH ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-20
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9371320600000X, 320800000X, 320900000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities