Healthcare Provider Details

I. General information

NPI: 1073848230
Provider Name (Legal Business Name): SPECIALIZED HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 E 1200 S STE 201
OREM UT
84058-6904
US

IV. Provider business mailing address

361 E 1200 S STE 201
OREM UT
84058-6904
US

V. Phone/Fax

Practice location:
  • Phone: 801-404-3528
  • Fax: 801-224-4914
Mailing address:
  • Phone: 801-404-3528
  • Fax: 801-224-4914

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: DR. WILLIAM ELLIS BUNN II
Title or Position: PHYSICIAN/OWNER
Credential: DO
Phone: 801-404-3528