Provider Demographics
NPI:1427480714
Name:SQUIRE BOYS, INC.
Entity type:Organization
Organization Name:SQUIRE BOYS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:SQUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-602-1802
Mailing Address - Street 1:415 MEDICAL DR STE C102
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8902
Mailing Address - Country:US
Mailing Address - Phone:801-335-0522
Mailing Address - Fax:801-335-0523
Practice Address - Street 1:415 MEDICAL DR STE C102
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8902
Practice Address - Country:US
Practice Address - Phone:801-335-0522
Practice Address - Fax:801-335-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2012-HOSPICE-92677251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based