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General NPI Number Information
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NPI Number | 1417629056
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Entity Type | Organization
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Legal Business Name | UTAH COUNTY HOME CARE LLC
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Dates
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Enumeration Date | 10/01/2021
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Last Update Date | 10/01/2021
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Provider Practice Location Address
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Address Line | 2230 N UNIVERSITY PKWY STE 4A
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City | PROVO
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State | UT
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Zip | 84604-6716
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Country | US
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Telephone | 801-696-4418
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Fax |
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Provider Business Mailing Address
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Address Line | 2230 N UNIVERSITY PKWY STE 4A
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City | PROVO
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State | UT
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Zip | 84604-6716
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Country | US
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Telephone | 801-696-4418
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK EDWARD WILLDER
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Credential |
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Telephone | 801-696-4418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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