Healthcare Provider Details

I. General information

NPI: 1790561744
Provider Name (Legal Business Name): SD HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/06/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 RIVER VIEW DR STE A
GREEN RIVER WY
82935-4811
US

IV. Provider business mailing address

598 W 900 S STE 220
WOODS CROSS UT
84010-8195
US

V. Phone/Fax

Practice location:
  • Phone: 307-875-7976
  • Fax: 307-875-8990
Mailing address:
  • Phone: 801-397-4697
  • Fax: 801-296-9117

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: BRAD MIKESELL
Title or Position: BOARD PRESIDENT
Credential:
Phone: 801-397-4000