Provider Demographics
NPI:1245597103
Name:DESERET HOME HEALTH, LLC
Entity Type:Organization
Organization Name:DESERET HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-977-0699
Mailing Address - Street 1:4111 W 2200 S
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-5697
Mailing Address - Country:US
Mailing Address - Phone:801-977-0699
Mailing Address - Fax:800-506-7024
Practice Address - Street 1:4111 W 2200 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84120-5697
Practice Address - Country:US
Practice Address - Phone:801-977-0699
Practice Address - Fax:800-506-7024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health