Healthcare Provider Details

I. General information

NPI: 1578670451
Provider Name (Legal Business Name): ALPINE SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 N 1100 E
AMERICAN FORK UT
84003-2917
US

IV. Provider business mailing address

169 N 1100 E
AMERICAN FORK UT
84003-2917
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-6060
  • Fax: 801-756-6060
Mailing address:
  • Phone: 801-756-6060
  • Fax: 801-756-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARJORIE SUSAN HORNE
Title or Position: MEDICAID MANAGER
Credential:
Phone: 801-756-6060