Provider Demographics
NPI:1497207740
Name:MIDAS CREEK HOME HEALTH & HOSPICE
Entity Type:Organization
Organization Name:MIDAS CREEK HOME HEALTH & HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:DARWIN
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:801-510-9191
Mailing Address - Street 1:1124 W S JORDAN PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-5515
Mailing Address - Country:US
Mailing Address - Phone:801-302-8526
Mailing Address - Fax:801-446-6883
Practice Address - Street 1:1124 W S JORDAN PKWY STE C
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5515
Practice Address - Country:US
Practice Address - Phone:801-302-8526
Practice Address - Fax:801-446-6883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health