Healthcare Provider Details

I. General information

NPI: 1700191103
Provider Name (Legal Business Name): WASATCH HOME HEALTH & HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 40TH ST
SOUTH OGDEN UT
84403-2236
US

IV. Provider business mailing address

710 40TH ST
SOUTH OGDEN UT
84403-2236
US

V. Phone/Fax

Practice location:
  • Phone: 801-916-1165
  • Fax:
Mailing address:
  • Phone: 801-916-1165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL S HASLAM
Title or Position: PRESIDENT
Credential:
Phone: 801-916-1165