Provider Demographics
NPI:1982905824
Name:YOUTHNET SERVICES, LLC
Entity Type:Organization
Organization Name:YOUTHNET SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY ASSURANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FAAOOTOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-420-4697
Mailing Address - Street 1:1160 SOUTH STATE STREET, SUITE 180A
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-8269
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1160 S STATE ST STE 180A
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-8269
Practice Address - Country:US
Practice Address - Phone:801-420-4697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT17265253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency