Provider Demographics
NPI:1316985930
Name:SIX COUNTY ASSOCIATION OF GOVERNMENT
Entity type:Organization
Organization Name:SIX COUNTY ASSOCIATION OF GOVERNMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF AGING
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-896-9222
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-0820
Mailing Address - Country:US
Mailing Address - Phone:435-896-9222
Mailing Address - Fax:435-896-9651
Practice Address - Street 1:250 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-2158
Practice Address - Country:US
Practice Address - Phone:435-896-9222
Practice Address - Fax:435-896-6951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT=========016Medicaid