Organization
LIFELINE BEHAVIORAL HEALTH, LLC
Active
Other names
Lifeline for Youth
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHANE R PETERSEN MBA (CHIEF EXECUTIVE OFFICER)
(801) 936-4000
Entity
Organization
Contact information
Practice address
1130 W CENTER ST, NORTH SALT LAKE, UT 84054-2917
(801) 936-4000
Mailing address
1130 W CENTER ST, NORTH SALT LAKE, UT 84054-2917
(801) 936-4000
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
07/18/2007
Last updated
04/10/2015
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us