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General NPI Number Information
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NPI Number | 1851988620
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Entity Type | Organization
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Legal Business Name | SEGO HOSPICE LLC
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Dates
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Enumeration Date | 12/28/2020
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Last Update Date | 12/28/2020
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Provider Practice Location Address
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Address Line | 286 N GATEWAY DR STE 101C
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City | PROVIDENCE
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State | UT
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Zip | 84332-5602
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Country | US
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Telephone | 435-881-5869
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Fax | 435-787-1365
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Provider Business Mailing Address
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Address Line | 286 N GATEWAY DR STE 101C
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City | PROVIDENCE
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State | UT
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Zip | 84332-5602
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Country | US
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Telephone | 435-881-5869
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA STOKES
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Credential | RN
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Telephone | 435-881-5869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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