Provider Demographics
NPI:1003853672
Name:ALLIANCE HOME HEALTH OF NORTHERN UTAH, LLC
Entity Type:Organization
Organization Name:ALLIANCE HOME HEALTH OF NORTHERN UTAH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-753-0707
Mailing Address - Street 1:965 S 100 W
Mailing Address - Street 2:STE. 204
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6062
Mailing Address - Country:US
Mailing Address - Phone:435-753-0707
Mailing Address - Fax:435-755-8505
Practice Address - Street 1:965 S 100 W
Practice Address - Street 2:STE. 204
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-6062
Practice Address - Country:US
Practice Address - Phone:435-753-0707
Practice Address - Fax:435-755-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6193670-0160251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT467228Medicare ID - Type Unspecified