Provider Demographics
NPI:1194580282
Name:BREKEN HOME CARE LLC
Entity type:Organization
Organization Name:BREKEN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINGHURST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-573-2411
Mailing Address - Street 1:5267 W DOCK ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-6242
Mailing Address - Country:US
Mailing Address - Phone:801-573-2411
Mailing Address - Fax:
Practice Address - Street 1:1935 E VINE ST STE 170
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-2197
Practice Address - Country:US
Practice Address - Phone:801-573-2411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care