Provider Demographics
NPI:1649462920
Name:TOOELE COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:TOOELE COUNTY HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY HEALTH SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:AHLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:435-843-2310
Mailing Address - Street 1:151 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2141
Mailing Address - Country:US
Mailing Address - Phone:435-843-2310
Mailing Address - Fax:435-843-2304
Practice Address - Street 1:151 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2141
Practice Address - Country:US
Practice Address - Phone:435-843-2310
Practice Address - Fax:435-843-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT690870121007Medicaid
UT998877663001Medicaid
UT=========002Medicaid