1609273309 NPI number — A HOME HEALTH CARE

Table of content: (NPI 1609273309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609273309 NPI number — A HOME HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A HOME HEALTH CARE
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:
AT HOME HEALTH CARE
Provider Other Organization Name Type Code:
3
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:
1609273309
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
840 WEST 1700 SOUTH #13
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-590-8900
Provider Business Mailing Address Fax Number:
801-590-8917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 W FOREST ST. SUITE 208
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIGHAM CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-695-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/24/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DEIS
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
801-590-8900

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  2014-HHA-89011 , 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)

  • Identifier: UT000349 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".