Provider Demographics
NPI:1043295744
Name:AT HOME PERSONAL CARE
Entity Type:Organization
Organization Name:AT HOME PERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWARTWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CSA
Authorized Official - Phone:801-746-5558
Mailing Address - Street 1:230 W 200 S
Mailing Address - Street 2:2215
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-1337
Mailing Address - Country:US
Mailing Address - Phone:801-746-5558
Mailing Address - Fax:801-746-5559
Practice Address - Street 1:230 W 200 S
Practice Address - Street 2:2215
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-1337
Practice Address - Country:US
Practice Address - Phone:801-746-5558
Practice Address - Fax:801-746-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT=========002Medicaid