Healthcare Provider Details

I. General information

NPI: 1669557864
Provider Name (Legal Business Name): GOOD SHEPHERD HOMECARE AND HOSPICE OF UTAH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3584 W 9000 S STE 300
WEST JORDAN UT
84088-5711
US

IV. Provider business mailing address

3584 W 9000 S STE 300
WEST JORDAN UT
84088-5711
US

V. Phone/Fax

Practice location:
  • Phone: 801-277-6474
  • Fax: 877-789-0498
Mailing address:
  • Phone: 801-277-6474
  • Fax: 877-789-0498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number2006-HOSPICE-72883
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KELLY J ANDERSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 801-277-6474