MEDICARE: MILLCREEK HOME HEALTH

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	2006HOSPICE70755	UT

General Provider Information

NPI Number	:	1093762221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLCREEK HOME HEALTH

Provider Business Mailing Address
First Line	:	1398 E LUCK LN
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2944
Country	:	US
Telephone Number	:	801-463-2478
Fax Number	:	801-486-0961

Provider Business Practice Location Address
First Line	:	1398 E LUCK LN
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2944
Country	:	US
Telephone Number	:	801-463-2478
Fax Number	:	801-486-0961

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. EINAT S GREEN
Credential	:	PT
Telephone Number	:	801-463-2478

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	01/24/2014

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