Northstar Youth Academy LLC

Primary specialty

Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X

License

11932 Issued in UT

Legal business name

NORTHSTAR YOUTH ACADEMY LLC

Practice address

900 Columbia LN
Provo, UT 84604-1320

Phone

(801) 787-6194

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Banks Bourgeous

Title

Co-Founder

Phone

(801) 369-4466

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1780782508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 COLUMBIA LN",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846041320",
            "telephone_number": "801-369-4466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 COLUMBIA LN",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846041320",
            "telephone_number": "801-787-6194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSTAR YOUTH ACADEMY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BOURGEOUS",
        "authorized_official_first_name": "BANKS",
        "authorized_official_title_or_position": "CO-FOUNDER",
        "authorized_official_telephone_number": "801-369-4466"
    },
    "taxonomies": [
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "UT",
            "license": "11932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Children's Substance Abuse Rehabilitation Facility in Provo, UT
• Providers in Provo, UT by specialty
• Children's Substance Abuse Rehabilitation Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.