Provider Demographics
NPI:1184939928
Name:UTAH YOUTH VILLAGE
Entity type:Organization
Organization Name:UTAH YOUTH VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TALON
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-272-9980
Mailing Address - Street 1:5800 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1359
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4388 HARVEST CREEK WAY
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-6902
Practice Address - Country:US
Practice Address - Phone:801-432-7808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children