Provider Demographics
NPI:1184781429
Name:ALPINE SCHOOL DISTRICT
Entity type:Organization
Organization Name:ALPINE SCHOOL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAID MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:M.
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-756-6060
Mailing Address - Street 1:169 N 1100 E
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2917
Mailing Address - Country:US
Mailing Address - Phone:801-756-6060
Mailing Address - Fax:801-756-6060
Practice Address - Street 1:350 N STATE ST
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-1830
Practice Address - Country:US
Practice Address - Phone:801-785-8727
Practice Address - Fax:801-785-8790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0603729S006251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0603729S006OtherCERTIFICATE NUMBER
UT=========Medicaid