Provider Demographics
NPI:1124410311
Name:MANAGING HOME CARE, INC.
Entity Type:Organization
Organization Name:MANAGING HOME CARE, INC.
Other - Org Name:HOME INSTEAD SENIOR CARE #109
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OUSSAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-266-9444
Mailing Address - Street 1:5005 S 900 E STE 120
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5711
Mailing Address - Country:US
Mailing Address - Phone:801-266-9444
Mailing Address - Fax:801-266-1003
Practice Address - Street 1:5005 S 900 E STE 120
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-5711
Practice Address - Country:US
Practice Address - Phone:801-266-9444
Practice Address - Fax:801-266-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2014-PCA-42983253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT289806859001Medicaid