National Provider Identifier Database

NORTHSTAR YOUTH ACADEMY LLC
Substance Abuse Treatment, Children

A facility or distinct part of a facility 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.


Contact Information

NORTHSTAR YOUTH ACADEMY LLC
900 COLUMBIA LN
PROVO, UT84604-1320
Phone: 801-787-6194
Fax:
Website:
Specialty Taxonomy Code
* Substance Abuse Treatment, Children 3245S0500X

* Indicates primary specialty

NPI Profile & details for NORTHSTAR YOUTH ACADEMY LLC

NPI Number 1780782508
Legal business name
LBN
NORTHSTAR YOUTH ACADEMY LLC
Authorized official BANKS BOURGEOUS - (CO-FOUNDER)
Entity Organization
Organization subpart No
Enumeration date 09/20/2006
Last updated 07/21/2022 - About 4 years ago
Sole proprietor1 Not specified
Identifiers
  • UT License #: 11932

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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