MEDICARE: HOSPICE FOR UTAH INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	2005-HOSPICE-897	UT

General Provider Information

NPI Number	:	1013900661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE FOR UTAH INC.

Provider Business Mailing Address
First Line	:	5097 S 900 E STE 100
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84117-5725
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5097 S 900 E STE 100
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84117-5725
Country	:	US
Telephone Number	:	801-576-1455
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RICHARD NEBEKER
Credential	:
Telephone Number	:	801-621-6642

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	11/06/2018

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