MEDICARE: ACCESS HOSPICE CARE OF SLC, 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	251G00000X	Community Based Hospice Care Agency	PENDING	UT

General Provider Information

NPI Number	:	1952555393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS HOSPICE CARE OF SLC, LLC

Provider Business Mailing Address
First Line	:	74 W 100 N
Second Line	:
City	:	LOGAN
State	:	UT
Zip	:	84321-4506
Country	:	US
Telephone Number	:	435-755-6599
Fax Number	:	435-755-6548

Provider Business Practice Location Address
First Line	:	9565 S 700 E
Second Line	:	200
City	:	SANDY
State	:	UT
Zip	:	84070-3482
Country	:	US
Telephone Number	:	801-495-3090
Fax Number	:	801-495-3088

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CATHY TARBET
Credential	:
Telephone Number	:	435-881-3104

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	02/11/2010

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