Healthcare Provider Details

I. General information

NPI: 1083986947
Provider Name (Legal Business Name): ACCESS PRIVATE DUTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 RICHMOND ST APT 106
SALT LAKE CITY UT
84106-3087
US

IV. Provider business mailing address

3080 RICHMOND STREET SUITE 106
SALT LAKE CITY UT
84106
US

V. Phone/Fax

Practice location:
  • Phone: 801-467-2880
  • Fax: 801-467-2940
Mailing address:
  • Phone: 801-467-2880
  • Fax: 801-467-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number2012-HHA-97078
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number2012-HHA-97078
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number2012-HHA-97078
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number2012-HHA-97078
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number2012-HHA-97078
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number2012-HHA -97078
License Number StateUT
# 7
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2012-HHA - 97078
License Number StateUT
# 8
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number2012-HHA - 97078
License Number StateUT
# 9
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number2011-HHA-97078
License Number StateUT

VIII. Authorized Official

Name: MR. JOHN WILLIAM SUMSION
Title or Position: OWNER - DIRECTOR
Credential: PHR
Phone: 801-319-8833