Healthcare Provider Details

I. General information

NPI: 1255331724
Provider Name (Legal Business Name): LIFEPATH HOSPICE AND FAMILY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5133 S 1500 W
RIVERDALE UT
84405-3926
US

IV. Provider business mailing address

655 BRAWLEY SCHOOL RD SUITE 200
MOORESVILLE NC
28117-9125
US

V. Phone/Fax

Practice location:
  • Phone: 801-293-0444
  • Fax: 801-263-9929
Mailing address:
  • Phone: 704-664-2876
  • Fax: 704-664-1306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number002501
License Number StateUT

VIII. Authorized Official

Name: DOUGLAS J ABELL
Title or Position: GENERAL COUNSEL/SEC
Credential:
Phone: 704-664-2876