=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114254224
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEOPLEFIRST HOMECARE & HOSPICE OF UTAH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2009
-----------------------------------------------------
Last Update Date | 11/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 942 CHAMBERS ST
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84403-5144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-475-6222
-----------------------------------------------------
Fax | 801-475-6061
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 942 CHAMBERS ST
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84403-5144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-475-6222
-----------------------------------------------------
Fax | 801-475-6061
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR. VICE PRESIDENT OF REIMBURSEMENT
-----------------------------------------------------
Name | MR. ARTHUR L. ROTHGERBER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-596-7300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 2009-HHA-76517
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------