Provider Demographics
NPI:1235470337
Name:INDEPENDENCE HOME CARE, LLC
Entity type:Organization
Organization Name:INDEPENDENCE HOME CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNSON
Authorized Official - Middle Name:T
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-698-9874
Mailing Address - Street 1:800 E. 2600 N.
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414
Mailing Address - Country:US
Mailing Address - Phone:801-298-1100
Mailing Address - Fax:801-298-1988
Practice Address - Street 1:800 E. 2600 N.
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414
Practice Address - Country:US
Practice Address - Phone:801-298-1100
Practice Address - Fax:801-298-1988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT3000825Medicaid