Healthcare Provider Details

I. General information

NPI: 1689303638
Provider Name (Legal Business Name): ELI HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5882 S 900 E STE 101
MURRAY UT
84121-1688
US

IV. Provider business mailing address

1881 TRAVERSE PARKWAY SUITE E #112
LEHI UT
84043
US

V. Phone/Fax

Practice location:
  • Phone: 801-542-7150
  • Fax:
Mailing address:
  • Phone: 801-455-8571
  • Fax: 801-335-6402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

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