MEDICARE: INTERMOUNTAIN HOME HEALTH 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	251E00000X	Home Health Agency	2006-HHA-72612	UT

General Provider Information

NPI Number	:	1528037264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERMOUNTAIN HOME HEALTH INC

Provider Business Mailing Address
First Line	:	5882 S 900 E
Second Line	:	SUITE 101
City	:	MURRAY
State	:	UT
Zip	:	84121-1683
Country	:	US
Telephone Number	:	801-542-7150
Fax Number	:	801-542-7154

Provider Business Practice Location Address
First Line	:	5882 S 900 E
Second Line	:	SUITE 101
City	:	MURRAY
State	:	UT
Zip	:	84121-1683
Country	:	US
Telephone Number	:	801-542-7150
Fax Number	:	801-542-7154

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID MICHAEL BRITSCH
Credential	:	RN
Telephone Number	:	801-542-7150

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	01/20/2012

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