MEDICARE: IRON COUNTY HOME HEALTH AGENCY

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	376J00000X	Homemaker	2004-HHA-139	UT
2	251E00000X	Home Health Agency	MPRN 2004-HHA-139	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386636280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRON COUNTY HOME HEALTH AGENCY

Provider Business Mailing Address
First Line	:	965 S MAIN ST
Second Line	:	SUITE 4
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-4383
Country	:	US
Telephone Number	:	435-586-3939
Fax Number	:	435-586-8275

Provider Business Practice Location Address
First Line	:	429 W 400 S
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-3199
Country	:	US
Telephone Number	:	435-586-3939
Fax Number	:	435-586-8275

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MAREE K PRINCE
Credential	:	RN BSN
Telephone Number	:	435-586-3939

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	07/09/2009

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Directions to “IRON COUNTY HOME HEALTH AGENCY ” Practice Location

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