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Life-Line, Inc. — NPI 1174711873, North Salt Lake, UT | NPI Central

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NPI 1174711873

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Life-Line, Inc.

NPI 1174711873 · Substance Use Disorder Rehabilitation Clinic/Center · North Salt Lake, UT

Provider details

NPI number: 1174711873
Entity type: Organization
Primary specialty: Substance Use Disorder Rehabilitation Clinic/CenterAmbulatory Health Care Facilities
Organization subpart: No
Authorized official: Shane Petersen, Chief Executive Officer(801) 936-4000
License: 11832 (UT)

Specialties & taxonomies

Substance Use Disorder Rehabilitation Clinic/CenterPrimary261QR0405XLicense 11832 (UT)
Ambulatory Health Care Facilities
Adolescent and Children Mental Health Clinic/Center261QM0855XLicense 11832 (UT)
Ambulatory Health Care Facilities

Practice location

1130 W Center St

North Salt Lake, UT 84054-2917

Phone: (801) 936-4000

Approximate (ZIP-level) locationGet directions

More UT providers

Mailing address

1130 W Center St

North Salt Lake, UT 84054-2917

Other names (DBA / former)

Doing business as: Lifeline for Youth

Registry dates

Enumerated: 2007-10-09
Last updated: 2011-10-21

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.