Healthcare Provider Details

I. General information

NPI: 1003809369
Provider Name (Legal Business Name): EZRA HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 W EXECUTIVE PKWY STE 320
LEHI UT
84048-5972
US

IV. Provider business mailing address

1881 W TRAVERSE PARKWAY SUITE E#112
LEHI UT
84048-6029
US

V. Phone/Fax

Practice location:
  • Phone: 801-225-0990
  • Fax: 801-225-4067
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2003-HHA-16212
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number2005-HOSPICE-65159
License Number StateUT

VIII. Authorized Official

Name: STEVEN BURNINGHAM
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 415-845-3213