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General NPI Number Information
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NPI Number | 1619192242
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Entity Type | Organization
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Legal Business Name | RED CANYON INC.
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2780 MADISON AVE
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City | OGDEN
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State | UT
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Zip | 84403-0112
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Country | US
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Telephone | 801-629-4663
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Fax | 801-612-2273
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Provider Business Mailing Address
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Address Line | 2780 MADISON AVE
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City | OGDEN
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State | UT
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Zip | 84403-0112
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Country | US
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Telephone | 801-629-4663
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Fax | 801-612-2273
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LOUIE J FRUCCI
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Credential | RN, CSA
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Telephone | 801-629-4663
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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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