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General NPI Number Information
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NPI Number | 1245597103
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Entity Type | Organization
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Legal Business Name | DESERET HOME HEALTH, LLC
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Dates
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Enumeration Date | 04/17/2012
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Last Update Date | 04/17/2012
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Provider Practice Location Address
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Address Line | 4111 W 2200 S
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City | WEST VALLEY
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State | UT
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Zip | 84120-5697
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Country | US
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Telephone | 801-977-0699
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Fax | 800-506-7024
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Provider Business Mailing Address
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Address Line | 4111 W 2200 S
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City | WEST VALLEY
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State | UT
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Zip | 84120-5697
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Country | US
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Telephone | 801-977-0699
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Fax | 800-506-7024
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MR. TROY LYNN JOLLEY
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Credential |
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Telephone | 801-977-0699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | UT
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