Provider Demographics
NPI:1871714048
Name:COUNTY OF TOOELE
Entity type:Organization
Organization Name:COUNTY OF TOOELE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:DYMOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-882-2870
Mailing Address - Street 1:59 E VINE ST
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2133
Mailing Address - Country:US
Mailing Address - Phone:435-882-2870
Mailing Address - Fax:435-882-6971
Practice Address - Street 1:59 E VINE ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2133
Practice Address - Country:US
Practice Address - Phone:435-882-2870
Practice Address - Fax:435-882-6971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========023Medicaid
UT=========001Medicaid