Provider Demographics
NPI:1144223249
Name:SPECIALTY NURSING SERVICES
Entity Type:Organization
Organization Name:SPECIALTY NURSING SERVICES
Other - Org Name:SPECIALTY NURSING SERVICES HOME HEALTH LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFLCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAWSHAWNI
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-732-2168
Mailing Address - Street 1:620 S 9500 E
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84317
Mailing Address - Country:US
Mailing Address - Phone:801-732-2178
Mailing Address - Fax:801-732-2173
Practice Address - Street 1:620 S 9500 E
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84317
Practice Address - Country:US
Practice Address - Phone:801-732-2178
Practice Address - Fax:801-732-2173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2004-HHA-844251E00000X
UT46D0925016291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
467110OtherMEDICARE OSCAR NUMBER
467110OtherMEDICARE OSCAR NUMBER
467110Medicare Oscar/Certification