Healthcare Provider Details

I. General information

NPI: 1598749798
Provider Name (Legal Business Name): AXIS IN-HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 TECHNOLOGY AVE STE F11-20
OREM UT
84097-6204
US

IV. Provider business mailing address

754 TECHNOLOGY AVE STE F11-20
OREM UT
84097-6204
US

V. Phone/Fax

Practice location:
  • Phone: 801-608-3882
  • Fax: 801-576-7536
Mailing address:
  • Phone: 801-608-3882
  • Fax: 801-576-7536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2004-HHA-42117
License Number StateUT

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. JAMES SAMUEL CLARK
Title or Position: OWNER-ADMIN
Credential:
Phone: 801-608-3882