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NORTHSTAR YOUTH ACADEMY LLC
NPI 1780782508
Substance Abuse Rehabilitation Facility - Substance Abuse Treatment, Children in Provo, UT

Active since September 20, 2006
900 COLUMBIA LN, PROVO, UT 84604(801) 787-6194 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: September 13, 2026.

Record update history: Jul 21, 2022, Aug 22, 2020 (2 updates tracked since 2020).

About Northstar Youth Academy Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NORTHSTAR YOUTH ACADEMY LLC (NPI 1780782508) is a healthcare organization registered as a substance abuse treatment, children in Provo, Utah and active in the NPI registry since September 2006. The organization lists Banks Bourgeous, Co-founder, as its authorized official.

NPPES Registry Identity

NPI1780782508
Entity TypeOrganization
Primary Taxonomy3245S0500X
Legal Business NameNORTHSTAR YOUTH ACADEMY LLC
Location Address900 COLUMBIA LNProvo, UT 84604-1320
Mailing Address920 Columbia LnProvo, UT 84604-1320 · (801) 369-4466
Phone(801) 787-6194
Organization SubpartNo
Authorized OfficialBanks BourgeousCo-founder · (801) 369-4466
Enumeration DateSeptember 20, 2006
Last NPPES UpdateJuly 21, 20222 updates tracked since enumeration
✔ NPI 1780782508 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySubstance Abuse Rehabilitation Facility · Substance Abuse Treatment, ChildrenResidential Treatment Facilities
Taxonomy Code3245S0500X
License✔ Licensed in UT · 11932
Definition
A facility or distinct part of a facility for children that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of children with disorders in the use of drugs, alcohol, and other substances. Medical and supportive counseling services and education services are included.
900 COLUMBIA LN, Provo, UT 84604
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JO KATHRYN FENSTERMAKER
Counselor
900 COLUMBIA LN
PROVO, UT 84604
Utah County (801) 375-4240
IAN PARHAM
Counselor
900 COLUMBIA LN
PROVO, UT 84604
Utah County (801) 375-4240
JOHN BRINDLE
Counselor
900 COLUMBIA LN
PROVO, UT 84604
Utah County (801) 375-4240
CAMBRIA HUNTER
Counselor
900 COLUMBIA LN
PROVO, UT 84604
Utah County (801) 375-4240
PAIGE WINTER ABBOTT
Counselor
900 COLUMBIA LN
PROVO, UT 84604
Utah County (801) 375-4240
NICOLE TRAPP TRINNAMAN
Counselor
900 COLUMBIA LN
PROVO, UT 84604
Utah County (801) 375-4240
SAMUEL RUNYAN
Counselor
900 COLUMBIA LN
PROVO, UT 84604
Utah County (801) 375-4240
ERYNLEA OLMSTEAD
Counselor
900 COLUMBIA LN
PROVO, UT 84604
Utah County (801) 375-4240

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Northstar Youth Academy LLC's NPI number?

The NPI number for Northstar Youth Academy LLC is 1780782508. It was assigned to this organization in the NPPES registry on September 20, 2006.

Where is Northstar Youth Academy LLC located?

Northstar Youth Academy LLC is located at 900 Columbia Ln, Provo, UT 84604. The listed phone number is (801) 787-6194.

What is Northstar Youth Academy LLC's specialty?

The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility, specializing in Substance Abuse Treatment, Children, with taxonomy code 3245S0500X.

When was this NPI record last updated?

The NPPES record for Northstar Youth Academy LLC was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.