Provider Demographics
NPI:1063697365
Name:UTAH HOMECARE LLC
Entity type:Organization
Organization Name:UTAH HOMECARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-774-9698
Mailing Address - Street 1:9231 S REDWOOD RD BLDG 4
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-6570
Mailing Address - Country:US
Mailing Address - Phone:801-774-9698
Mailing Address - Fax:801-469-6394
Practice Address - Street 1:9231 S REDWOOD RD BLDG 4
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-6570
Practice Address - Country:US
Practice Address - Phone:801-566-1185
Practice Address - Fax:801-469-6394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2007-HHA-75934251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health