OrganizationActive
Northstar Youth Academy LLC
NPI 1780782508 · Children's Substance Abuse Rehabilitation Facility · Provo, UT
Provider details
- NPI number
- 1780782508
- Entity type
- Organization
- Primary specialty
- Children's Substance Abuse Rehabilitation FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Banks Bourgeous, Co-Founder(801) 369-4466
- License
- 11932 (UT)
Specialties & taxonomies
Residential Treatment Facilities
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
900 Columbia Ln
Provo, UT 84604-1320
Phone: (801) 787-6194
Street-level locationGet directions
Mailing address
920 Columbia Ln
Provo, UT 84604-1320
Registry dates
- Enumerated
- 2006-09-20
- Last updated
- 2022-07-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.