Provider Demographics
NPI:1083887855
Name:CLINICIANS AT HOME, LLC
Entity Type:Organization
Organization Name:CLINICIANS AT HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:FALLERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-232-0010
Mailing Address - Street 1:903 CARNATION DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-4532
Mailing Address - Country:US
Mailing Address - Phone:801-232-0010
Mailing Address - Fax:
Practice Address - Street 1:903 CARNATION DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-4532
Practice Address - Country:US
Practice Address - Phone:801-232-0010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6917817-0160251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management