Healthcare Provider Details

I. General information

NPI: 1841803137
Provider Name (Legal Business Name): ANYWHERE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/26/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9980 S. 300 W. SUITE 200
SANDY UT
84070
US

IV. Provider business mailing address

8850 S 700 E UNIT 1849
SANDY UT
84091-6074
US

V. Phone/Fax

Practice location:
  • Phone: 801-810-8267
  • Fax:
Mailing address:
  • Phone: 801-810-8267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHANE JAIMEZ
Title or Position: PRESIDENT/CEO
Credential:
Phone: 801-810-8267