MEDICARE: PEREGRINE HOME HEALTH 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

General Provider Information

NPI Number	:	1922252790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEREGRINE HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	1133 N MAIN ST # 300
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-4800
Country	:	US
Telephone Number	:	801-546-7417
Fax Number	:	801-546-5230

Provider Business Practice Location Address
First Line	:	1133 N MAIN ST STE 300
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-4800
Country	:	US
Telephone Number	:	801-546-7417
Fax Number	:	801-546-5230

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JEFFREY SCOTT VINING
Credential	:	MHA
Telephone Number	:	801-546-7417

Provider Enumeration Date	:	11/06/2008
Last Update Date	:	12/27/2022

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Directions to “PEREGRINE HOME HEALTH LLC ” Practice Location

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