Provider Demographics
NPI:1982808705
Name:HILDALE TOWN CORP
Entity type:Organization
Organization Name:HILDALE TOWN CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-874-2400
Mailing Address - Street 1:PO BOX 841588
Mailing Address - Street 2:
Mailing Address - City:HILDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84784-1588
Mailing Address - Country:US
Mailing Address - Phone:435-874-2400
Mailing Address - Fax:435-874-2753
Practice Address - Street 1:900 NORTH 350 EAST
Practice Address - Street 2:
Practice Address - City:HILDALE
Practice Address - State:UT
Practice Address - Zip Code:84784-1588
Practice Address - Country:US
Practice Address - Phone:435-874-2400
Practice Address - Fax:435-874-2753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2720L3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ314568Medicaid
AZ314568Medicaid
UT=========009Medicaid