Provider Demographics
NPI:1154604635
Name:AT HOME NURSING CARE LLC
Entity type:Organization
Organization Name:AT HOME NURSING CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWARTWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-746-5558
Mailing Address - Street 1:5242 COLLEGE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2706
Mailing Address - Country:US
Mailing Address - Phone:801-266-5126
Mailing Address - Fax:801-266-0775
Practice Address - Street 1:5242 COLLEGE DR STE 210
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-2706
Practice Address - Country:US
Practice Address - Phone:801-266-5126
Practice Address - Fax:801-266-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2012-HHA-103153251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========OtherMEDICARE
UT46-7051Medicare PIN