MEDICARE: OHANA HOSPICE

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

General Provider Information

NPI Number	:	1730562208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHANA HOSPICE

Provider Business Mailing Address
First Line	:	PO BOX 1494
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-8494
Country	:	US
Telephone Number	:	801-903-2595
Fax Number	:	801-999-7157

Provider Business Practice Location Address
First Line	:	623 E FORT UNION BLVD
Second Line	:	SUITE 108
City	:	MIDVALE
State	:	UT
Zip	:	84047-5528
Country	:	US
Telephone Number	:	801-903-2595
Fax Number	:	801-999-7157

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIKE LOFGRAN
Credential	:
Telephone Number	:	801-231-8811

Provider Enumeration Date	:	07/02/2015
Last Update Date	:	07/02/2015

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Directions to “OHANA HOSPICE ” Practice Location

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