Provider Demographics
NPI:1548872724
Name:CARE YOUTH CORPORATION-LAVA HEIGHTS
Entity type:Organization
Organization Name:CARE YOUTH CORPORATION-LAVA HEIGHTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-880-3339
Mailing Address - Street 1:747 E SAINT GEORGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:435-674-0843
Practice Address - Street 1:730 EAST SPRING DRIVE
Practice Address - Street 2:
Practice Address - City:TOQUERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84774-7742
Practice Address - Country:US
Practice Address - Phone:435-674-0843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT607155Medicaid