Healthcare Provider Details

I. General information

NPI: 1730507161
Provider Name (Legal Business Name): DIRECT CARE MEDICAL HOME CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 S JORDAN LANDING BLVD STE 200
WEST JORDAN UT
84084-5612
US

IV. Provider business mailing address

7611 S JORDAN LANDING BLVD STE 200
WEST JORDAN UT
84084-5612
US

V. Phone/Fax

Practice location:
  • Phone: 801-260-1919
  • Fax: 801-260-1441
Mailing address:
  • Phone: 801-260-1919
  • Fax: 801-260-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateUT

VIII. Authorized Official

Name: DR. RACHOT K VACHAROTHONE
Title or Position: OWNER/ URGENT CARE PHYSICIAN
Credential: MD
Phone: 801-260-1919