Healthcare Provider Details

I. General information

NPI: 1154604635
Provider Name (Legal Business Name): AT HOME NURSING CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5242 COLLEGE DR STE 210
MURRAY UT
84123-2706
US

IV. Provider business mailing address

5242 COLLEGE DR STE 210
MURRAY UT
84123-2706
US

V. Phone/Fax

Practice location:
  • Phone: 801-266-5126
  • Fax: 801-266-0775
Mailing address:
  • Phone: 801-266-5126
  • Fax: 801-266-0775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2012-HHA-103153
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: RANDY SWARTWOOD
Title or Position: PRESIDENT
Credential:
Phone: 801-746-5558