Healthcare Provider Details

I. General information

NPI: 1346587698
Provider Name (Legal Business Name): ACCESS PRIVATE DUTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 E MAIN ST STE 4
AMERICAN FORK UT
84003-2678
US

IV. Provider business mailing address

359 E. MAIN STREET SUITE # 4
AMERICAN FORK UT
84003
US

V. Phone/Fax

Practice location:
  • Phone: 801-642-2665
  • Fax: 801-642-2667
Mailing address:
  • Phone: 801-642-2667
  • Fax: 801-642-2667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number2012-HHA-97078
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number2012-HHA-97078
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number2012-HHA-97078
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number2012-HHA-97078
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number2012-HHA-97078
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2012-HHA-97078
License Number StateUT

VIII. Authorized Official

Name: MR. JOHN W. SUMSION
Title or Position: HOME CARE DIRECTOR
Credential: SPHR
Phone: 801-642-2665