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LIFELINE FOR YOUTH
NPI 1780884742
Substance Abuse Rehabilitation Facility - Substance Abuse Treatment, Children in North Salt Lake, UT

Active since July 18, 2007CLIA 46D2048587 · Waiver
1130 W CENTER ST, NORTH SALT LAKE, UT 84054(801) 936-4000 Get Directions Write a Review

NPPES record last updated: April 10, 2015. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Lifeline For Youth NPPES

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

LIFELINE FOR YOUTH (NPI 1780884742) is a healthcare organization registered as a substance abuse treatment, children in North Salt Lake, Utah and active in the NPI registry since July 2007. The organization holds a CLIA Waiver certificate valid through October 17, 2026 and lists Shane R Petersen, Chief Executive Officer, as its authorized official.

NPPES Registry Identity

NPI1780884742
Entity TypeOrganization
Primary Taxonomy3245S0500X
Legal Business NameLIFELINE BEHAVIORAL HEALTH, LLC
Location Address1130 W CENTER STNorth Salt Lake, UT 84054-2917
Mailing Address1130 W Center StNorth Salt Lake, UT 84054-2917 · (801) 936-4000
Phone(801) 936-4000
Organization SubpartNo
Authorized OfficialShane R PetersenChief Executive Officer · (801) 936-4000
Enumeration DateJuly 18, 2007
Last NPPES UpdateApril 10, 2015
✔ NPI 1780884742 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtySubstance Abuse Rehabilitation Facility · Substance Abuse Treatment, ChildrenResidential Treatment Facilities
Taxonomy Code3245S0500X
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.
Also ListedClinic/Center · Adolescent and Children Mental HealthTaxonomy 261QM0855X
Also ListedClinic/Center · Rehabilitation, Substance Use DisorderTaxonomy 261QR0405X
Also ListedPsychiatric Residential Treatment FacilityTaxonomy 323P00000X
1130 W CENTER ST, North Salt Lake, UT 84054
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Other Names 1

Doing Business AsLifeline For Youth

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 46D2048587

Lifeline Behavioral Health, LLC · North Salt Lake, UT
Active · expires Oct 17, 2026
CLIA Number46D2048587
Laboratory TypeResidential Treatment
Certificate Effective DateOctober 18, 2024
Certificate Expiration DateOctober 17, 2026
Laboratory DirectorShane R. Petersen
Laboratory Phone(801) 936-4000
Laboratory LocationLifeline Behavioral Health, LLC1130 West Center Street, North Salt Lake, UT 84054
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

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

RALPH WILLIAM KNAPP M.D.
Psychiatry & Neurology (Child & Adolescent Psychiatry)
1130 W CENTER ST
NORTH SALT LAKE, UT 84054
Davis County (801) 936-4000
LIFE-LINE, INC.
Clinic/Center (Rehabilitation, Substance Use Disorder)
1130 W CENTER ST
NORTH SALT LAKE, UT 84054
Davis County (801) 936-4000
LIFE-LINE, INC.
Substance Abuse Rehabilitation Facility
1130 W CENTER ST
NORTH SALT LAKE, UT 84054
Davis County (801) 936-4000

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 Lifeline Behavioral Health, LLC's NPI number?

The NPI number for Lifeline Behavioral Health, LLC is 1780884742. It was assigned to this organization in the NPPES registry on July 18, 2007. The provider is doing business as Lifeline For Youth.

Where is Lifeline Behavioral Health, LLC located?

Lifeline Behavioral Health, LLC is located at 1130 W Center St, North Salt Lake, UT 84054. The listed phone number is (801) 936-4000.

What is Lifeline Behavioral Health, 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.

Does Lifeline Behavioral Health, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 46D2048587) is associated with this NPI, valid through October 17, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lifeline Behavioral Health, LLC was last updated on April 10, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.