Healthcare Provider Details

I. General information

NPI: 1831196146
Provider Name (Legal Business Name): UNITED HOME CARE OF NORTHERN CALIFORNIA, LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 NEW YORK RANCH RD STE C
JACKSON CA
95642-2147
US

IV. Provider business mailing address

350 E 300 S STE 100
BOUNTIFUL UT
84010-4914
US

V. Phone/Fax

Practice location:
  • Phone: 209-223-3866
  • Fax: 209-223-9453
Mailing address:
  • Phone: 801-397-4100
  • Fax: 801-397-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number100000267
License Number StateCA

VIII. Authorized Official

Name: DEE R BANGERTER
Title or Position: PRESIDENT
Credential:
Phone: 801-397-4000