Healthcare Provider Details

I. General information

NPI: 1932646221
Provider Name (Legal Business Name): IPTI HOME HEALTH AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4568 S HIGHLAND DR STE 180
SALT LAKE CITY UT
84117-4236
US

IV. Provider business mailing address

4568 S HIGHLAND DR STE 180
SALT LAKE CITY UT
84117-4236
US

V. Phone/Fax

Practice location:
  • Phone: 801-251-0258
  • Fax:
Mailing address:
  • Phone: 801-251-0258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2017HHAUT000792
License Number StateUT

VIII. Authorized Official

Name: MURIEL J LEE
Title or Position: MANAGER AND MEMBER
Credential: PT
Phone: 801-251-0258