Provider Demographics
NPI:1578434767
Name:BEAR RIVER ASSOCIATION OF GOVERNMENTS
Entity type:Organization
Organization Name:BEAR RIVER ASSOCIATION OF GOVERNMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:DOREY
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-713-1400
Mailing Address - Street 1:170 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4567
Mailing Address - Country:US
Mailing Address - Phone:435-752-7242
Mailing Address - Fax:435-752-6962
Practice Address - Street 1:170 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4567
Practice Address - Country:US
Practice Address - Phone:435-752-7242
Practice Address - Fax:435-752-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty