Organization
AEGIS YOUTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ASHLEY KENNON COOPER JR. (OWNER)
(801) 636-3816
Entity
Organization
Contact information
Practice address
982 W 910 S, PROVO, UT 84601-5634
(801) 636-3816
Mailing address
982 W 910 S, PROVO, UT 84601-5634
(801) 636-3816
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
13427
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13427
DEPT OF HUMAN SERVICES
UT
Enumeration date
04/08/2008
Last updated
04/08/2008
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