Provider Demographics
NPI:1699084566
Name:YOUNG WOMEN'S EMPOWERMENT CENTER LONG TERM 1
Entity type:Organization
Organization Name:YOUNG WOMEN'S EMPOWERMENT CENTER LONG TERM 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SDS REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-283-9932
Mailing Address - Street 1:68 N 180 W
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627-2130
Mailing Address - Country:US
Mailing Address - Phone:435-283-9934
Mailing Address - Fax:435-283-4920
Practice Address - Street 1:68 N 180 W
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-2130
Practice Address - Country:US
Practice Address - Phone:435-283-9934
Practice Address - Fax:435-283-4920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT16463320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness