LIFELINE BEHAVIORAL HEALTH, LLC (NPI# 1780884742) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780884742 |
| Entity Type | Organization |
| Organization Name | LIFELINE BEHAVIORAL HEALTH, LLC |
| Other Organization Name | LIFELINE FOR YOUTH |
| Practice Address |
1130 W Center St North Salt Lake UT 84054-2917 |
| Practice Telephone | 8019364000 |
| Mailing Telephone | 8019364000 |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2015-04-10 |
| Authorized Official Name | MR. SHANE R PETERSEN (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 8019364000 |
| Authorized Official Credential | MBA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 323P00000X | Psychiatric Residential Treatment Facility | Residential Treatment Facilities | ||
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities | ||
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities | ||
| Y | 3245S0500X |
Substance Abuse Rehabilitation Facility Specialization: Substance Abuse Treatment, Children |
Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Lifeline for Youth | Doing Business As Name - Organization |
| Street Address |
1130 W CENTER ST |
| City | NORTH SALT LAKE |
| State | UT |
| Zip Code | 84054-2917 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073674768 | Ralph William Knapp | Psychiatry & Neurology | 1130 W Center St, North Salt Lake, UT 84054-2917 | 2006-12-13 |
| 1699943118 | Life-line, Inc. | Substance Abuse Rehabilitation Facility | 1130 W Center St, North Salt Lake, UT 84054-2917 | 2008-02-19 |
| 1174711873 | Life-line, Inc. | Clinic/Center | 1130 W Center St, North Salt Lake, UT 84054-2917 | 2007-10-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801307962 | Melou Stewart Cline | Music Therapist | 1130 Eaglewood Loop, North Salt Lake, UT 84054 | 2017-10-17 |
| 1083157382 | Badger Management LLC | Pharmacy | 725 N Redwood Road, N Salt Lake, UT 84054 | 2016-11-18 |
| 1790161495 | Clayton Brimhall | Social Worker | 951 South Silvertree Lane, North Salt Lake, UT 84054 | 2015-08-04 |
| 1124423215 | Orbit Onsite Care Clinic | Internal Medicine | 845 North Overland Rd., North Salt Lake, UT 84054 | 2014-10-31 |
| 1972865244 | Ray A Dumas | Community/Behavioral Health | 144 S. 300 E., North Salt Lake City, UT 84054 | 2012-06-13 |
| 1699060624 | Jeanne Marie Chadwick | Massage Therapist | 955 Elizabeth Dr., Nsl, UT 84054 | 2011-06-17 |
| 1447368634 | Wendy Louise Wolfe | Speech-Language Pathologist | 774 East Independence Way, North Salt Lake City, UT 84054 | 2006-08-28 |
| 1558603209 | Thomas Alan Duernberger | Pharmacist | 669 W 900 N, North Salt Lake, UT 84054 | 2013-03-20 |
| 1710493283 | Danielle Jeanne Merritt | Behavioral Analyst | 919 Callie Ct, North Salt Lake, UT 84054-0165 | 2017-12-20 |
| 1326503053 | Elevation Behavioral Science Services, Pllc | Community/Behavioral Health | 919 Callie Ct, North Salt Lake, UT 84054-0165 | 2019-02-06 |
| Find all providers in zip 84054 | ||||
| Taxonomy Code | 3245S0500X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| Specialization | 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. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952790099 | Lorraine Michelle Ivey | Substance Abuse Rehabilitation Facility | 115 N 200 E, Washington, UT 84780-1642 | 2015-01-13 |
| 1912328576 | Heather Jenkins | Substance Abuse Rehabilitation Facility | 6200 South 3809 West, Kearns, UT 84129 | 2013-12-30 |
| 1477819878 | Mt Pleasant Campus | Substance Abuse Rehabilitation Facility | 1170 South 70 West, Mt. Pleasant, UT 84647 | 2012-04-10 |
| 1821382318 | Terri Butcher | Substance Abuse Rehabilitation Facility | 66 North 180 West, Ephriam, UT 84627-1111 | 2011-06-02 |
| 1154641926 | Triumph Youth Services | Substance Abuse Rehabilitation Facility | 58 S 950 W, Brigham City, UT 84302-4424 | 2010-06-03 |
| 1922323203 | Catalyst Residential Treatment | Substance Abuse Rehabilitation Facility | 970 S 1025 W, Brigham City, UT 84302-6711 | 2010-03-30 |
| 1003014648 | Eagle Ranch Academy | Substance Abuse Rehabilitation Facility | 115 W 1470 S, St George, UT 84770-6763 | 2007-07-05 |
| 1780782508 | Northstar Youth Academy LLC | Substance Abuse Rehabilitation Facility | 900 Columbia Ln, Provo, UT 84604-1320 | 2006-09-20 |
| 1083073985 | Eric Peter Rydzewski | Substance Abuse Rehabilitation Facility | 344 E 100 S, Suite 301, Salt Lake City, UT 84111-1700 | 2016-02-19 |
| 1639565260 | Salt Creek Addiction Recovery Services | Substance Abuse Rehabilitation Facility | 21360 N 1450 E, Moroni, UT 84646 | 2015-04-10 |
| Find all providers with the same taxonomy | ||||
| City | NORTH SALT LAKE |
| Zip Code | 84054 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.