Provider Demographics
NPI:1417629056
Name:UTAH COUNTY HOME CARE LLC
Entity Type:Organization
Organization Name:UTAH COUNTY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WILLDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-696-4418
Mailing Address - Street 1:2230 N UNIVERSITY PKWY STE 4A
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6716
Mailing Address - Country:US
Mailing Address - Phone:801-696-4418
Mailing Address - Fax:
Practice Address - Street 1:2230 N UNIVERSITY PKWY STE 4A
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6716
Practice Address - Country:US
Practice Address - Phone:801-696-4418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care