Healthcare Provider Details

I. General information

NPI: 1558520213
Provider Name (Legal Business Name): ENCORE, L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 S MAIN ST STE 2A
BRIGHAM CITY UT
84302-2526
US

IV. Provider business mailing address

33 S MAIN ST STE 2A
BRIGHAM CITY UT
84302-2526
US

V. Phone/Fax

Practice location:
  • Phone: 435-734-0655
  • Fax:
Mailing address:
  • Phone: 435-734-0655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS ADAM LARSEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 435-757-8368