MEDICARE: PALLIATIVE CARE FOR UTAH 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1932633997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALLIATIVE CARE FOR UTAH LLC

Provider Business Mailing Address
First Line	:	5097 S 900 E STE 100
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84117-5725
Country	:	US
Telephone Number	:	801-576-1455
Fax Number	:	801-576-1472

Provider Business Practice Location Address
First Line	:	5097 S 900 E STE 100
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84117-5725
Country	:	US
Telephone Number	:	801-576-1455
Fax Number	:	801-576-1472

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RICHARD NEBEKER
Credential	:
Telephone Number	:	208-524-0685

Provider Enumeration Date	:	04/17/2017
Last Update Date	:	11/06/2018

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