Provider Demographics
NPI:1083932727
Name:PIONEER YOUTH & ADULT COMMUNITY SERVICES
Entity type:Organization
Organization Name:PIONEER YOUTH & ADULT COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEIMA
Authorized Official - Middle Name:MUTI
Authorized Official - Last Name:TUPUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-474-2500
Mailing Address - Street 1:PO BOX 651372
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84165-1372
Mailing Address - Country:US
Mailing Address - Phone:801-474-2500
Mailing Address - Fax:801-474-9117
Practice Address - Street 1:3030 S MAIN ST STE 400
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-3578
Practice Address - Country:US
Practice Address - Phone:801-474-2500
Practice Address - Fax:801-474-9117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT16168251S00000X
UT16167253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251S00000XAgenciesCommunity/Behavioral Health