MEDICARE: WILLOW CREEK HEALTH CARE

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	251E00000X	Home Health Agency		UT

General Provider Information

NPI Number	:	1215938469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW CREEK HEALTH CARE

Provider Business Mailing Address
First Line	:	1935 VINE ST
Second Line	:	SUITE 420
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-2192
Country	:	US
Telephone Number	:	801-281-9669
Fax Number	:	801-281-0179

Provider Business Practice Location Address
First Line	:	1935 VINE ST
Second Line	:	SUITE 420
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-2192
Country	:	US
Telephone Number	:	801-281-9669
Fax Number	:	801-281-0179

Authorized Official
Title or Position	:	ADMINISTRATOR CFO
Name	:	MR. TRACE D OSBORNE
Credential	:	CPA
Telephone Number	:	801-281-9669

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/31/2007

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