Northstar Youth Academy LLC

NPI #1780782508 in Provo, Utah

Provider Information

NPI Number: 1780782508
Entity Type: Organization
Organization Name: Northstar Youth Academy LLC
Primary Specialty: Substance Abuse Rehabilitation Facility - Substance Abuse Treatment, Children
Enumeration Date: Sep 20, 2006
Last Updated: Jul 21, 2022

Practice Location

Address: 900 COLUMBIA LN
City: Provo
State: Utah
ZIP Code: 84604-1320
Phone: (801) 787-6194

Authorized Official

Name: BANKS BOURGEOUS
Title: CO-FOUNDER
Phone: (801) 369-4466

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Substance Abuse Rehabilitation Facility - Substance Abuse Treatment, Children — Substance Abuse Treatment, Children	3245S0500X	Primary

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