MEDICARE: PARAMOUNT PEDIATRIC HOME HEALTH, INC.

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		UT

General Provider Information

NPI Number	:	1144416280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARAMOUNT PEDIATRIC HOME HEALTH, INC.

Provider Business Mailing Address
First Line	:	1037 STATE CIR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-1362
Country	:	US
Telephone Number	:	801-359-5437
Fax Number	:	801-532-3855

Provider Business Practice Location Address
First Line	:	1037 STATE CIR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-1362
Country	:	US
Telephone Number	:	801-359-5437
Fax Number	:	801-532-3855

Authorized Official
Title or Position	:	PRESIDENT, COO, DON
Name	:	SHAUNA D SHIFLETT
Credential	:	R.N.
Telephone Number	:	801-694-9983

Provider Enumeration Date	:	09/21/2007
Last Update Date	:	07/21/2022

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