Healthcare Provider Details

I. General information

NPI: 1205194222
Provider Name (Legal Business Name): INDEPENDENCE HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 W 700 S STE 201
WOODS CROSS UT
84087-1458
US

IV. Provider business mailing address

707 W 700 S STE 201
WOODS CROSS UT
84087-1458
US

V. Phone/Fax

Practice location:
  • Phone: 801-298-1100
  • Fax: 801-298-1988
Mailing address:
  • Phone: 801-298-1100
  • Fax: 801-298-1988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHNSON WEBB
Title or Position: MANAGING PARTNER
Credential:
Phone: 801-698-9874