Provider Demographics
NPI:1831229731
Name:UTAH YOUTH VILLAGE
Entity type:Organization
Organization Name:UTAH YOUTH VILLAGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BJORKLUND
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:801-272-9980
Mailing Address - Fax:801-272-9976
Practice Address - Street 1:5800 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-1359
Practice Address - Country:US
Practice Address - Phone:801-272-9980
Practice Address - Fax:801-272-9976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12081104100000X, 251B00000X
UT12080322D00000X
UT12070-12073,12082-83322D00000X
UT12124-25,12489322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Not Answered251B00000XAgenciesCase Management
Not Answered322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT788007788668Medicaid
UT788007788668Medicaid