Provider Demographics
NPI:1518151406
Name:ACCESS HOME MEDICAL LLC
Entity Type:Organization
Organization Name:ACCESS HOME MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGUM
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN
Authorized Official - Phone:435-755-6599
Mailing Address - Street 1:4300 HARRISON BLVD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3186
Mailing Address - Country:US
Mailing Address - Phone:801-475-7500
Mailing Address - Fax:
Practice Address - Street 1:4300 HARRISON BLVD
Practice Address - Street 2:SUITE 12
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3186
Practice Address - Country:US
Practice Address - Phone:801-475-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies