National Provider Identifier Database

LIFELINE BEHAVIORAL HEALTH 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

LIFELINE BEHAVIORAL HEALTH, LLC
1130 W CENTER ST
NORTH SALT LAKE, UT84054-2917
Phone: 801-936-4000
Fax:
Website:
Specialty Taxonomy Code
* Substance Abuse Treatment, Children 3245S0500X
Adolescent and Children Mental Health 261QM0855X
Psychiatric Residential Treatment Facility 323P00000X
Rehabilitation, Substance Use Disorder 261QR0405X

* Indicates primary specialty

NPI Profile & details for LIFELINE BEHAVIORAL HEALTH, LLC

NPI Number 1780884742
Legal business name
LBN
LIFELINE BEHAVIORAL HEALTH, LLC
Authorized official SHANE PETERSEN - (CHIEF EXECUTIVE OFFICER)
Entity Organization
Organization subpart No
Enumeration date 07/18/2007
Last updated 04/10/2015 - About 11 years ago
Sole proprietor1 Not specified
Identifiers n/a

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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