Provider Demographics
NPI:1194112037
Name:UT - SIGNATURE HPC LLC
Entity type:Organization
Organization Name:UT - SIGNATURE HPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:NEBEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-524-0685
Mailing Address - Street 1:3544 E 17TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-6911
Mailing Address - Country:US
Mailing Address - Phone:208-524-0685
Mailing Address - Fax:208-524-0686
Practice Address - Street 1:3544 E 17TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-6911
Practice Address - Country:US
Practice Address - Phone:208-524-0685
Practice Address - Fax:208-524-0686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based