Healthcare Provider Details

I. General information

NPI: 1851578546
Provider Name (Legal Business Name): MOUNTAINLAND ASSOCIATION OF GOVERNMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

586 E 800 N
OREM UT
84097-4146
US

IV. Provider business mailing address

586 E 800 N
OREM UT
84097-4146
US

V. Phone/Fax

Practice location:
  • Phone: 801-229-3806
  • Fax: 801-229-3671
Mailing address:
  • Phone: 801-229-3806
  • Fax: 801-229-3671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. SCOTT MCBETH
Title or Position: DIRECTOR, AGING & FAMILY SERVICES
Credential:
Phone: 801-229-3806