Provider Demographics
NPI:1518287267
Name:IHC HEALTH SERVICES INC
Entity Type:Organization
Organization Name:IHC HEALTH SERVICES INC
Other - Org Name:INTERMOUNTAIN HOMECARE HOME HEALTH CASSIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP & COO
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MACEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-887-6275
Mailing Address - Street 1:11520 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-7805
Mailing Address - Country:US
Mailing Address - Phone:385-887-6000
Mailing Address - Fax:801-442-0603
Practice Address - Street 1:1501 HILAND AVE STE Z
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2688
Practice Address - Country:US
Practice Address - Phone:208-678-8844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHH-114251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1518287267Medicaid
ID0034670Medicaid