NPI: 1780884742
Provider Name: LIFELINE BEHAVIORAL HEALTH, LLC
Doing Business As: LIFELINE FOR YOUTH
Classification: Substance Abuse Rehabilitation Facility - 3245S0500X
Entity Type: Organization
Specialization: Substance Abuse Treatment, Children
CLIA Number: 46D2048587
Address:
1130 W CENTER ST
NORTH SALT LAKE, UT
ZIP 84054
Phone: (801) 936-4000
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LIFELINE BEHAVIORAL HEALTH, LLC is a substance abuse treatment and children substance abuse rehabilitation facility in North Salt Lake, UT. The provider is a facility or distinct part of a facility for children that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of children with disorders in the use of drugs, alcohol, and other substances. Medical and supportive counseling services and education services are included. LIFELINE BEHAVIORAL HEALTH, LLC NPI is 1780884742. The provider is registered as an organization entity type.
The provider Is Doing Business As Lifeline For Youth.
The provider's business location address is:
1130 W CENTER ST
NORTH SALT LAKE, UT
ZIP 84054-917
Phone: (801) 936-4000
The provider's authorized official is Shane R Petersen .
The authorized official title is Chief Executive Officer and has the following contact phone number (801) 936-4000.
The CLIA number assigned to this NPI record is 46D2048587 - other - residential treatment with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 7/18/2007 and was last updated on 4/10/2015.