Provider Demographics
NPI:1659314268
Name:FIVE COUNTY ASSOCIATION OF GOVERNMENTS
Entity Type:Organization
Organization Name:FIVE COUNTY ASSOCIATION OF GOVERNMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-673-3548
Mailing Address - Street 1:PO BOX 1550
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84771-1550
Mailing Address - Country:US
Mailing Address - Phone:435-673-3548
Mailing Address - Fax:435-673-3540
Practice Address - Street 1:1070 WEST 1600 SOUTH
Practice Address - Street 2:BLD B
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-673-3548
Practice Address - Fax:435-673-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
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=========002Medicaid