Healthcare Provider Details

I. General information

NPI: 1801034475
Provider Name (Legal Business Name): ACCESS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102293 HYW 89 S
THAYNE WY
83127
US

IV. Provider business mailing address

74 W 100 N
LOGAN UT
84321-4506
US

V. Phone/Fax

Practice location:
  • Phone: 307-883-7583
  • Fax:
Mailing address:
  • Phone: 435-755-6599
  • Fax: 435-755-6548

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: MR. CHAD MANGUM
Title or Position: CLINICAL ADMINISTRATOR
Credential: BSN
Phone: 435-755-6599