Provider Demographics
NPI:1114219755
Name:ALLIANCE HOME HEALTH OF SOUTHERN UTAH, LLC
Entity Type:Organization
Organization Name:ALLIANCE HOME HEALTH OF SOUTHERN UTAH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:435-753-3133
Mailing Address - Street 1:491 E RIVERSIDE DR
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7051
Mailing Address - Country:US
Mailing Address - Phone:435-656-2889
Mailing Address - Fax:435-656-2877
Practice Address - Street 1:491 E RIVERSIDE DR
Practice Address - Street 2:SUITE 3B
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7051
Practice Address - Country:US
Practice Address - Phone:435-656-2889
Practice Address - Fax:435-656-2877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health