Healthcare Provider Details

I. General information

NPI: 1932633997
Provider Name (Legal Business Name): PALLIATIVE CARE FOR UTAH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5097 S 900 E STE 100
MURRAY UT
84117-5725
US

IV. Provider business mailing address

5097 S 900 E STE 100
MURRAY UT
84117-5725
US

V. Phone/Fax

Practice location:
  • Phone: 801-576-1455
  • Fax: 801-576-1472
Mailing address:
  • Phone: 801-576-1455
  • Fax: 801-576-1472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: RICHARD NEBEKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 208-524-0685