=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801440201
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WASATCH WORX HOME HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2019
-----------------------------------------------------
Last Update Date | 07/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 375 N MAIN ST STE 103
-----------------------------------------------------
City | KAYSVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84037-1272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-497-1907
-----------------------------------------------------
Fax | 801-459-7106
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 61 E COBURN CIR
-----------------------------------------------------
City | KAYSVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84037-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-497-1907
-----------------------------------------------------
Fax | 801-459-7106
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. HEATHER MAE SWARENS
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 801-497-1907
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------