Organization
NORTHSTAR YOUTH ACADEMY LLC
Active
Organization
NORTHSTAR YOUTH ACADEMY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BANKS BOURGEOUS (CO-FOUNDER)
(801) 369-4466
Entity
Organization
Contact information
Practice address
900 COLUMBIA LN, PROVO, UT 84604-1320
(801) 787-6194
Mailing address
920 COLUMBIA LN, PROVO, UT 84604-1320
(801) 369-4466
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
11932
UT
Other
Enumeration date
09/20/2006
Last updated
07/21/2022
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