Healthcare Provider Details

I. General information

NPI: 1982963492
Provider Name (Legal Business Name): BYBEE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11075 S STATE ST SUITE 12B
SANDY UT
84070-5164
US

IV. Provider business mailing address

11075 S STATE ST SUITE 12B
SANDY UT
84070-5164
US

V. Phone/Fax

Practice location:
  • Phone: 801-912-8400
  • Fax: 801-912-8401
Mailing address:
  • Phone: 801-912-8400
  • Fax: 801-912-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number7999866-0160
License Number StateUT

VIII. Authorized Official

Name: DENAE BYBEE
Title or Position: OWNER/CEO
Credential: LPN
Phone: 801-912-8400