=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588895676
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WASATCH HOME HEALTH CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2009
-----------------------------------------------------
Last Update Date | 02/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9103 S 1300 W SUITE # 102
-----------------------------------------------------
City | WEST JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84088-6706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-953-1713
-----------------------------------------------------
Fax | 801-953-1519
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9103 S 1300 W SUITE # 102
-----------------------------------------------------
City | WEST JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84088-6706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-953-1713
-----------------------------------------------------
Fax | 801-953-1519
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. FLORENCE N GEO-JAJA
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 801-953-1713
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 2009-HHA-89048
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------