Provider Demographics
NPI:1083769277
Name:CREST HOME HEALTH AND HOSPICE, LLC
Entity Type:Organization
Organization Name:CREST HOME HEALTH AND HOSPICE, LLC
Other - Org Name:CREST HOME HEALTH AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BANGERTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-397-4000
Mailing Address - Street 1:576 W 900 S
Mailing Address - Street 2:SUITE 260
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8194
Mailing Address - Country:US
Mailing Address - Phone:801-397-4100
Mailing Address - Fax:801-397-4197
Practice Address - Street 1:700 W IRONWOOD DR
Practice Address - Street 2:STE 255
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2656
Practice Address - Country:US
Practice Address - Phone:208-765-4343
Practice Address - Fax:208-667-0494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHH-124251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID131557Medicare Oscar/Certification
ID137070Medicare Oscar/Certification