Provider Demographics
NPI:1609273309
Name:A HOME HEALTH CARE
Entity type:Organization
Organization Name:A HOME HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-590-8900
Mailing Address - Street 1:840 WEST 1700 SOUTH #13
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104
Mailing Address - Country:US
Mailing Address - Phone:801-590-8900
Mailing Address - Fax:801-590-8917
Practice Address - Street 1:9 W FOREST ST. SUITE 208
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302
Practice Address - Country:US
Practice Address - Phone:435-695-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2014-HHA-89011251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTUT000349Medicaid
UT467252Medicare PIN