MEDICARE: ALLIANCE HOME HEALTH, LLC

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	:	1568556470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	965 S 100 W
Second Line	:	SUITE 204
City	:	LOGAN
State	:	UT
Zip	:	84321-6062
Country	:	US
Telephone Number	:	435-753-0707
Fax Number	:	435-755-8505

Provider Business Practice Location Address
First Line	:	1245 BRICKYARD RD
Second Line	:	SUITE 350
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2559
Country	:	US
Telephone Number	:	801-261-8437
Fax Number	:	801-261-5463

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. JUSTIN LARSEN
Credential	:
Telephone Number	:	435-753-0707

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/22/2020

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