Provider Demographics
NPI:1154496594
Name:IHC HEALTH SERVICES INC
Entity type:Organization
Organization Name:IHC HEALTH SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP-HOMECARE HOSPICE PALLIATIVE CARE
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PROVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-442-2000
Mailing Address - Street 1:11520 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-7805
Mailing Address - Country:US
Mailing Address - Phone:385-887-6000
Mailing Address - Fax:801-442-0603
Practice Address - Street 1:555 S BLUFF ST STE 100
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7320
Practice Address - Country:US
Practice Address - Phone:435-251-2367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1154496594Medicaid