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NPI Code Detail

MEDICARE: SD HEALTH SERVICES LLC

MEDICARE: SD HEALTH SERVICES 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
1251G00000XCommunity Based Hospice Care Agency

General Provider Information

NPI Number : 1912748765
Entity Type Code : Organization
Provider Name (Legal Business Name) : SD HEALTH SERVICES LLC
Provider Business Mailing Address
First Line : 598 W 900 S STE 220
Second Line :
City : WOODS CROSS
State : UT
Zip : 84010-8195
Country : US
Telephone Number : 801-397-4697
Fax Number : 801-296-9117
Provider Business Practice Location Address
First Line : 175 RIVER VIEW DR STE A
Second Line :
City : GREEN RIVER
State : WY
Zip : 82935-4811
Country : US
Telephone Number : 307-875-7976
Fax Number :
Authorized Official
Title or Position : BOARD PRESIDENT
Name : BRAD MIKESELL
Credential :
Telephone Number : 801-397-4000
Provider Enumeration Date : 06/05/2024
Last Update Date : 06/05/2024

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Directions to “SD HEALTH SERVICES LLC ” Practice Location

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