Healthcare Provider Details

I. General information

NPI: 1235470337
Provider Name (Legal Business Name): INDEPENDENCE HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 04/25/2024
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E. 2600 N.
NORTH OGDEN UT
84414
US

IV. Provider business mailing address

800 E. 2600 N.
NORTH OGDEN UT
84414
US

V. Phone/Fax

Practice location:
  • Phone: 801-298-1100
  • Fax: 801-298-1988
Mailing address:
  • Phone: 801-298-1100
  • Fax: 801-298-1988

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: JOHNSON T WEBB
Title or Position: MANAGING PARTNER
Credential:
Phone: 801-698-9874