NPIMap

Organization Active NPI

Life-Line, Inc.

Doing business as Lifeline for Youth

  • Substance Use Disorder Rehabilitation Clinic/Center
  • North Salt Lake, UT
National Provider Identifier
1174711873
Registry record updated Oct 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
11832 Issued in UT
Legal business name
LIFE-LINE, INC.
Doing business as
Lifeline for Youth
Practice address
1130 W Center St
North Salt Lake, UT 84054-2917
Phone
(801) 936-4000
NPI assigned
Oct 9, 2007
Last updated
Oct 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Shane R Petersen, MBA
Title
Chief Executive Officer
Phone
(801) 936-4000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 11832 UT
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 11832 UT Primary

Addresses

Primary practice location

1130 W Center St
North Salt Lake, UT 84054-2917

Mailing address

1130 W Center St
North Salt Lake, UT 84054-2917
Phone (801) 936-4000

Other names 1

  • Lifeline for Youth Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Life-Line Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

  • Life-Line, Inc.

    dba Lifeline for Youth

    • Substance Abuse Rehabilitation Facility
    • North Salt Lake, UT
    • NPI 1699943118
    NPD tax ID

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319155200000",
    "number": "1174711873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 W CENTER ST",
            "city": "NORTH SALT LAKE",
            "state": "UT",
            "postal_code": "840542917",
            "telephone_number": "801-936-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 W CENTER ST",
            "city": "NORTH SALT LAKE",
            "state": "UT",
            "postal_code": "840542917",
            "telephone_number": "801-936-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE-LINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-09",
        "last_updated": "2011-10-21",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "801-936-4000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "UT",
            "license": "11832",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "UT",
            "license": "11832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifeline for Youth",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Salt Lake, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.