Provider Demographics
NPI:1386636280
Name:IRON COUNTY HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:IRON COUNTY HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAREE
Authorized Official - Middle Name:K
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:435-586-3939
Mailing Address - Street 1:965 S MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-4383
Mailing Address - Country:US
Mailing Address - Phone:435-586-3939
Mailing Address - Fax:435-586-8275
Practice Address - Street 1:429 W 400 S
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-3199
Practice Address - Country:US
Practice Address - Phone:435-586-3939
Practice Address - Fax:435-586-8275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTMPRN 2004-HHA-139251E00000X
UT2004-HHA-139376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT87-6000310005Medicaid
UT87-6000310005Medicaid