1659505501 NPI number — HOSPICE CARE OF NORTHERN UTAH, LLC

Table of content: (NPI 1659505501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659505501 NPI number — HOSPICE CARE OF NORTHERN UTAH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE CARE OF NORTHERN UTAH, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659505501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2721 N HWY 89
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
PLEASANT VIEW
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84404-6258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-689-3049
Provider Business Mailing Address Fax Number:
801-689-3045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2721 N HWY 89
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
PLEASANT VIEW
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84404-6258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-689-3049
Provider Business Practice Location Address Fax Number:
801-689-3045
Provider Enumeration Date:
05/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WOOD
Authorized Official First Name:
EILEEN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
801-689-3049

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  1015860 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com