Provider Demographics
NPI:1306929153
Name:HORIZON HOME HEALTH LC
Entity type:Organization
Organization Name:HORIZON HOME HEALTH LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:BENSON
Authorized Official - Last Name:WOOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:801-225-7171
Mailing Address - Street 1:11 E 200 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-4737
Mailing Address - Country:US
Mailing Address - Phone:801-225-7171
Mailing Address - Fax:
Practice Address - Street 1:906 N NAVAJO DR
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:AZ
Practice Address - Zip Code:86040-0975
Practice Address - Country:US
Practice Address - Phone:928-645-9110
Practice Address - Fax:928-645-9410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA3429251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0702870OtherBLUE CROSS
AZ929185Medicaid
AZAZ0702870OtherBLUE CROSS