Healthcare Provider Details

I. General information

NPI: 1609315431
Provider Name (Legal Business Name): AT HOME CARE AND HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 05/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 S 315 E
IVINS UT
84738-5054
US

IV. Provider business mailing address

639 S 315 E
IVINS UT
84738-5054
US

V. Phone/Fax

Practice location:
  • Phone: 435-256-0867
  • Fax: 435-652-3675
Mailing address:
  • Phone: 435-256-0867
  • Fax: 435-652-3675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number2016-PCA-UT000780
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number2016-PCA-UT000780
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number2016-PCA-UT000780
License Number StateUT

VIII. Authorized Official

Name: MRS. ASHLYN TEED
Title or Position: ADMINISTRATOR
Credential: OWNER
Phone: 435-256-0867