Organization
LIFELINE BEHAVIORAL HEALTH, LLC
Active
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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up