Healthcare Provider Details

I. General information

NPI: 1730562208
Provider Name (Legal Business Name): OHANA HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 E FORT UNION BLVD SUITE 108
MIDVALE UT
84047-5528
US

IV. Provider business mailing address

PO BOX 1494
WEST JORDAN UT
84084-8494
US

V. Phone/Fax

Practice location:
  • Phone: 801-903-2595
  • Fax: 801-999-7157
Mailing address:
  • Phone: 801-903-2595
  • Fax: 801-999-7157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MIKE LOFGRAN
Title or Position: PRESIDENT
Credential:
Phone: 801-231-8811