=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902378417
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 1 ASSIST CARE OF UTAH VALLEY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2018
-----------------------------------------------------
Last Update Date | 12/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 180 N UNIVERSITY AVENUE SUITE 270, OFFICE 213
-----------------------------------------------------
City | PROVO
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-852-0072
-----------------------------------------------------
Fax | 888-384-0874
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3965 W 2000 S
-----------------------------------------------------
City | REXBURG
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83440-4012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-557-4215
-----------------------------------------------------
Fax | 888-384-0874
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ANDREW RAIL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 208-557-4215
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------