1578178547 NPI number — SIGNATURE HOME HEALTH ST.GEORGE, LLC

Table of content: (NPI 1578178547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578178547 NPI number — SIGNATURE HOME HEALTH ST.GEORGE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIGNATURE HOME HEALTH ST.GEORGE, 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:
6
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:
1578178547
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25117 SW PARKWAY AVE STE F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILSONVILLE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97070-9697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
971-224-2505
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1525 EAST OVATION PLACE
Provider Second Line Business Practice Location Address:
STE 2010
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-414-8533
Provider Business Practice Location Address Fax Number:
435-414-9924
Provider Enumeration Date:
09/15/2020

Additional Information

Authorized Official

Authorized Official Last Name:
KOFSTAD
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIVISION PRESIDENT
Authorized Official Telephone Number:
971-224-2033

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com