Healthcare Provider Details

I. General information

NPI: 1194380113
Provider Name (Legal Business Name): CENTERFIELD HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 S 900 E STE 202
ST GEORGE UT
84790-7003
US

IV. Provider business mailing address

354 W CENTERFIELD CIR
WASHINGTON UT
84780-8483
US

V. Phone/Fax

Practice location:
  • Phone: 435-862-5940
  • Fax:
Mailing address:
  • Phone: 435-359-4599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CLINT JOHN HOOPES
Title or Position: ADMINISTRATOR
Credential:
Phone: 435-359-4599