Provider Demographics
NPI:1366558785
Name:MOUNTAINLAND ASSOCIATION OF GOVERNMENTS DEPT. OF AGING & FAMILY SVCS.
Entity type:Organization
Organization Name:MOUNTAINLAND ASSOCIATION OF GOVERNMENTS DEPT. OF AGING & FAMILY SVCS.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, DEPT. OF AGING & FAMILY S
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-229-3805
Mailing Address - Street 1:586 E 800 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4146
Mailing Address - Country:US
Mailing Address - Phone:801-229-3805
Mailing Address - Fax:801-229-3671
Practice Address - Street 1:586 E 800 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-4146
Practice Address - Country:US
Practice Address - Phone:801-229-3805
Practice Address - Fax:801-229-3671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT001251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid