Healthcare Provider Details

I. General information

NPI: 1528037264
Provider Name (Legal Business Name): INTERMOUNTAIN HOME HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5882 S 900 E SUITE 101
MURRAY UT
84121-1683
US

IV. Provider business mailing address

5882 S 900 E SUITE 101
MURRAY UT
84121-1683
US

V. Phone/Fax

Practice location:
  • Phone: 801-542-7150
  • Fax: 801-542-7154
Mailing address:
  • Phone: 801-542-7150
  • Fax: 801-542-7154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2006-HHA-72612
License Number StateUT

VIII. Authorized Official

Name: MR. DAVID MICHAEL BRITSCH
Title or Position: PRESIDENT
Credential: RN
Phone: 801-542-7150