1609315431 NPI number — AT HOME CARE AND HEALTH SERVICES LLC

Table of content: (NPI 1609315431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609315431 NPI number — AT HOME CARE AND HEALTH SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AT HOME CARE AND HEALTH SERVICES 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:
1609315431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
639 S 315 E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IVINS
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84738-5054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-256-0867
Provider Business Mailing Address Fax Number:
435-652-3675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
639 S 315 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IVINS
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84738-5054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-256-0867
Provider Business Practice Location Address Fax Number:
435-652-3675
Provider Enumeration Date:
02/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
TEED
Authorized Official First Name:
ASHLYN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
435-256-0867

Provider Taxonomy Codes

  • Taxonomy code: 251T00000X , with the licence number:  2016-PCA-UT000780 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 347C00000X , with the licence number: 2016-PCA-UT000780 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X , with the licence number: 2016-PCA-UT000780 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1700331162 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1700331162 . This is a "MOLINA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 1700331162 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 1700331162 . This is a "SELECT HEALTH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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