MEDICARE: DESERET CARE 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	163WH1000X	Hospice Registered Nurse	5930686	UT
2	163WH1000X	Hospice Registered Nurse		UT

General Provider Information

NPI Number	:	1821024316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERET CARE LLC

Provider Business Mailing Address
First Line	:	1405 WEST 2200 SOUTH
Second Line	:	STE 200
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84119
Country	:	US
Telephone Number	:	801-973-0900
Fax Number	:	801-973-9571

Provider Business Practice Location Address
First Line	:	1405 WEST 2200 SOUTH
Second Line	:	STE 200
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84119
Country	:	US
Telephone Number	:	801-973-0900
Fax Number	:	801-973-9571

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	MR. STEVEN L LOVE
Credential	:	RRT
Telephone Number	:	801-973-0900

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	04/20/2008

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Directions to “DESERET CARE LLC ” Practice Location

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