Provider Demographics
NPI:1972622777
Name:BEAR RIVER ASSOCIATION OF GOVERNMENTS
Entity Type:Organization
Organization Name:BEAR RIVER ASSOCIATION OF GOVERNMENTS
Other - Org Name:BEAR RIVER AREA AGENCY ON AGING
Other - Org Type:Other Name
Authorized Official - Title/Position:AGING SERVICES DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-713-1460
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:435-713-1460
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:435-713-1460
Practice Address - Fax:435-752-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
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