Provider Demographics
NPI:1538413489
Name:ADAGIO HOSPICE LLC
Entity type:Organization
Organization Name:ADAGIO HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:C
Authorized Official - Last Name:MATHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-367-6294
Mailing Address - Street 1:845 S MAIN ST STE C6
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6482
Mailing Address - Country:US
Mailing Address - Phone:801-335-7297
Mailing Address - Fax:801-335-2466
Practice Address - Street 1:845 S MAIN ST STE C6
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6482
Practice Address - Country:US
Practice Address - Phone:801-335-7297
Practice Address - Fax:801-335-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT461602Medicare Oscar/Certification