Provider Demographics
NPI:1376895367
Name:HOSPICE HOMECARE LLC
Entity Type:Organization
Organization Name:HOSPICE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-400-3073
Mailing Address - Street 1:789 BAMBERGER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2181
Mailing Address - Country:US
Mailing Address - Phone:801-763-1009
Mailing Address - Fax:801-763-1051
Practice Address - Street 1:789 BAMBERGER DR
Practice Address - Street 2:SUITE B
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2181
Practice Address - Country:US
Practice Address - Phone:801-763-1009
Practice Address - Fax:801-763-1051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based