MEDICARE: TOOELE HOME CARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	2005-HHA-14227	UT

General Provider Information

NPI Number	:	1013996768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOOELE HOME CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	1887 NORTH AARON DR
Second Line	:	SUITE D
City	:	TOOELE
State	:	UT
Zip	:	84074-8138
Country	:	US
Telephone Number	:	435-882-4163
Fax Number	:	435-882-7821

Provider Business Practice Location Address
First Line	:	1887 NORTH AARON DR
Second Line	:	SUITE D
City	:	TOOELE
State	:	UT
Zip	:	84074-8138
Country	:	US
Telephone Number	:	435-882-4163
Fax Number	:	435-882-7821

Authorized Official
Title or Position	:	DIRECTOR OF BUSINESS OFFICE SUPPORT
Name	:	MS. LAURIE HOLTSFORD
Credential	:
Telephone Number	:	615-465-7466

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	10/21/2011

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