Provider Demographics
NPI:1508896820
Name:WEBER & HENSHAW, INC.
Entity Type:Organization
Organization Name:WEBER & HENSHAW, INC.
Other - Org Name:SPECTRUM HOME SERVICES-SLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-506-0415
Mailing Address - Street 1:4772 PLUM ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-3613
Mailing Address - Country:US
Mailing Address - Phone:801-506-0415
Mailing Address - Fax:801-263-0251
Practice Address - Street 1:4772 PLUM ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-3613
Practice Address - Country:US
Practice Address - Phone:801-506-0415
Practice Address - Fax:801-263-0251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid