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General NPI Number Information
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NPI Number | 1730923491
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Entity Type | Organization
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Legal Business Name | MAFASHOMECARE
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Dates
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Enumeration Date | 06/19/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 3004 W 1350 N
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City | PROVO
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State | UT
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Zip | 84601-5793
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Country | US
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Telephone | 801-404-0937
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Fax |
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Provider Business Mailing Address
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Address Line | 3004 W 1350 N
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City | PROVO
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State | UT
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Zip | 84601-5793
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Country | US
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Telephone | 801-404-0937
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Fax |
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Authorized Official
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Title or Position | BOSS
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Name | LAVERNA F LESA
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Credential |
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Telephone | 801-404-0937
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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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