MEDICARE: GREEN ROCK HOME CARE 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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1558219543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN ROCK HOME CARE INC

Provider Business Mailing Address
First Line	:	10808 S RIVER FRONT PKWY STE 3094
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-5939
Country	:	US
Telephone Number	:	801-509-4559
Fax Number	:

Provider Business Practice Location Address
First Line	:	10808 S RIVER FRONT PKWY STE 300
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-5761
Country	:	US
Telephone Number	:	801-509-4559
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. MISALEILANI ROCK HOME CARE LIAVA'A
Credential	:
Telephone Number	:	801-509-4559

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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