| Lifeline For Youth | |
|
1130 W Center St North Salt Lake UT 84054-2917 | |
| (801) 936-4000 | |
| Not Available |
| Full Name | Lifeline For Youth |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 1130 W Center St, North Salt Lake, Utah |
| Authorized Official Name and Position | Shane R Petersen (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8019364000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifeline For Youth 1130 W Center St North Salt Lake UT 84054-2917 Ph: (801) 936-4000 | Lifeline For Youth 1130 W Center St North Salt Lake UT 84054-2917 Ph: (801) 936-4000 |
| NPI Number | 1174711873 |
|---|---|
| Provider Enumeration Date | 10/09/2007 |
| Last Update Date | 10/21/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174711873 | NPI | - | NPPES |
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