Provider Demographics
NPI:1457439705
Name:ALLIANCE HOME CARE, INC.
Entity Type:Organization
Organization Name:ALLIANCE HOME CARE, INC.
Other - Org Name:GOOD SHEPHERD HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-277-6474
Mailing Address - Street 1:5383 S 900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-7264
Mailing Address - Country:US
Mailing Address - Phone:801-277-6474
Mailing Address - Fax:801-277-6475
Practice Address - Street 1:5383 S 900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-7264
Practice Address - Country:US
Practice Address - Phone:801-277-6474
Practice Address - Fax:801-277-6475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2006-HHA-43191251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT810582329001Medicaid
UT810582329001Medicaid