Lifeline Behavioral Health, Llc, NPI 1780884742
Children's Substance Abuse Rehabilitation Facility in North Salt Lake, UT, US
NPI number: what is it?
The NPI, or National Provider Identifier, is a non-repeatable number for health care providers. The NPI always consists of 10 digits and is used for administrative and financial procedures. The NPI wa...
| NPI | 1780884742 |
| NPI Entity Type | Organization |
| Provider Name |
Lifeline Behavioral Health, Llc
Doing Business As |
| Enumeration Date | September 30, 2009 |
| Last Update Date | September 30, 2009 |
| Provider Location Address | 1130 W Center St, North Salt Lake, UT, US |
| Provider Mailing Address | 1130 W Center St, North Salt Lake, UT, US, 840542917 |
| Is Sole Proprietor? | No |
Organization Official
| Official Name | MR. MBA Shane R Petersen |
| Official Position | CHIEF EXECUTIVE OFFICER |
| Phone | 801-936-4000 |
Primary Taxonomy
| Taxonomy Code | |
| Taxonomy Name | Children's Substance Abuse Rehabilitation Facility |
| Classification | |
| Group | |
| Description | 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. |
Secondary Taxonomies
| Taxonomy Code | Group | Classification | License No. | State | Primary? |
|---|---|---|---|---|---|
| No | |||||
| No | |||||
| No |
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Damaris Villalobos Individual |
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Dylan Smart Individual |
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Alexis Suzanne Goodwin Individual |
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