1992708945 NPI number — LIFE CARE AT HOME OF UTAH, INC.

Table of content: (NPI 1992708945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992708945 NPI number — LIFE CARE AT HOME OF UTAH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE CARE AT HOME OF UTAH, INC.
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:
1992708945
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 KEITH ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37312-3713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-473-5256
Provider Business Mailing Address Fax Number:
423-559-8356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 W PARKWAY BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84119-2099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-972-5802
Provider Business Practice Location Address Fax Number:
801-973-0246
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR DIRECTOR OF FINANCE
Authorized Official Telephone Number:
423-473-5257

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  2004-HHA-231 , 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)





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