Provider Demographics
NPI:1164597464
Name:MIDAS CREEK HOME HEALTH LLC
Entity Type:Organization
Organization Name:MIDAS CREEK HOME HEALTH LLC
Other - Org Name:MIDAS CREEK HOME HEALTH & HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEISA
Authorized Official - Middle Name:O
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:801-302-8526
Mailing Address - Street 1:1124 W SOUTH JORDAN PKWY
Mailing Address - Street 2:STE C
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-5509
Mailing Address - Country:US
Mailing Address - Phone:801-302-8526
Mailing Address - Fax:801-446-6883
Practice Address - Street 1:1124 W SOUTH JORDAN PKWY
Practice Address - Street 2:STE C
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5509
Practice Address - Country:US
Practice Address - Phone:801-302-8526
Practice Address - Fax:801-446-6883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2007-HHA-80451251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT467238Medicare Oscar/Certification