Provider Demographics
NPI:1407529720
Name:HOMERUN CRISIS INTERVENTION SERVICES LLC
Entity Type:Organization
Organization Name:HOMERUN CRISIS INTERVENTION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:435-452-2662
Mailing Address - Street 1:PO BOX 437
Mailing Address - Street 2:
Mailing Address - City:HYRUM
Mailing Address - State:UT
Mailing Address - Zip Code:84319-0437
Mailing Address - Country:US
Mailing Address - Phone:435-452-2662
Mailing Address - Fax:
Practice Address - Street 1:205 QUARTER CIR
Practice Address - Street 2:
Practice Address - City:NIBLEY
Practice Address - State:UT
Practice Address - Zip Code:84321-6317
Practice Address - Country:US
Practice Address - Phone:855-660-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Single Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty