Healthcare Provider Details

I. General information

NPI: 1205600319
Provider Name (Legal Business Name): HOBBLE CREEK HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/09/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 S 1530 W
SPRINGVILLE UT
84663-6500
US

IV. Provider business mailing address

1303 S 1530 W
SPRINGVILLE UT
84663-6500
US

V. Phone/Fax

Practice location:
  • Phone: 385-625-7923
  • Fax:
Mailing address:
  • Phone: 385-625-7923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SIPOLA MAKAI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 385-625-7923