Provider Demographics
NPI:1346587698
Name:ACCESS PRIVATE DUTY, LLC
Entity Type:Organization
Organization Name:ACCESS PRIVATE DUTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME CARE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SUMSION
Authorized Official - Suffix:
Authorized Official - Credentials:SPHR
Authorized Official - Phone:801-642-2665
Mailing Address - Street 1:359 E. MAIN STREET SUITE # 4
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003
Mailing Address - Country:US
Mailing Address - Phone:801-642-2667
Mailing Address - Fax:801-642-2667
Practice Address - Street 1:359 E MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2678
Practice Address - Country:US
Practice Address - Phone:801-642-2665
Practice Address - Fax:801-642-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2012-HHA-97078171M00000X, 251B00000X, 251C00000X, 251S00000X, 253Z00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1083986947Medicaid