Healthcare Provider Details

I. General information

NPI: 1275356131
Provider Name (Legal Business Name): KCP UTAH INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12227 S BUSINESS PARK DR STE 115
DRAPER UT
84020-6558
US

IV. Provider business mailing address

12227 S BUSINESS PARK DR STE 115
DRAPER UT
84020-6558
US

V. Phone/Fax

Practice location:
  • Phone: 801-890-2723
  • Fax: 801-890-2851
Mailing address:
  • Phone: 801-890-2723
  • Fax: 801-890-2851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KENNETH MICHAEL PLYMALE
Title or Position: OWNER
Credential:
Phone: 385-535-3066