Healthcare Provider Details

I. General information

NPI: 1720038094
Provider Name (Legal Business Name): ACCESS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 W BURNSIDE AVE SUITE E
CHUBBUCK ID
83202-2411
US

IV. Provider business mailing address

74 W 100 N
LOGAN UT
84321-4506
US

V. Phone/Fax

Practice location:
  • Phone: 208-637-2273
  • Fax: 208-637-8867
Mailing address:
  • Phone: 435-755-6599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CATHY TARBET
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 435-755-6599