Healthcare Provider Details

I. General information

NPI: 1962961748
Provider Name (Legal Business Name): MOUNTAIN PEAK HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 N UNIVERSITY AVE STE 104
PROVO UT
84601-8423
US

IV. Provider business mailing address

961 W CENTER ST
OREM UT
84057-5203
US

V. Phone/Fax

Practice location:
  • Phone: 801-377-2760
  • Fax:
Mailing address:
  • Phone: 801-377-2760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: AMBER L TUELLER
Title or Position: SECRETARY
Credential:
Phone: 208-207-2726