Provider Demographics
NPI:1497720080
Name:REFINED HOSPICE LLC
Entity Type:Organization
Organization Name:REFINED HOSPICE LLC
Other - Org Name:REFINED HEALTHCARE SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-879-2664
Mailing Address - Street 1:623 E FORT UNION BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-5529
Mailing Address - Country:US
Mailing Address - Phone:801-261-9490
Mailing Address - Fax:801-261-5856
Practice Address - Street 1:623 E FORT UNION BLVD STE 105
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-5529
Practice Address - Country:US
Practice Address - Phone:801-261-9490
Practice Address - Fax:801-261-5856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT201316982001Medicaid
461542Medicare Oscar/Certification