Healthcare Provider Details

I. General information

NPI: 1386636280
Provider Name (Legal Business Name): IRON COUNTY HOME HEALTH AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 W 400 S
CEDAR CITY UT
84720-3199
US

IV. Provider business mailing address

965 S MAIN ST SUITE 4
CEDAR CITY UT
84720-4383
US

V. Phone/Fax

Practice location:
  • Phone: 435-586-3939
  • Fax: 435-586-8275
Mailing address:
  • Phone: 435-586-3939
  • Fax: 435-586-8275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberMPRN 2004-HHA-139
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number2004-HHA-139
License Number StateUT

VIII. Authorized Official

Name: MRS. MAREE K PRINCE
Title or Position: ADMINISTRATOR
Credential: RN BSN
Phone: 435-586-3939