Healthcare Provider Details

I. General information

NPI: 1174026488
Provider Name (Legal Business Name): PMA CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 4500 S STE D210
SALT LAKE CITY UT
84107-2968
US

IV. Provider business mailing address

1716 E ORCHARD DR
SALT LAKE CITY UT
84106-3257
US

V. Phone/Fax

Practice location:
  • Phone: 801-758-0630
  • Fax: 801-758-0620
Mailing address:
  • Phone: 801-758-0630
  • Fax: 801-758-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number2016-PCA-102355
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: FRANK BARTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 801-758-0630