Provider Demographics
NPI:1528037264
Name:INTERMOUNTAIN HOME HEALTH INC
Entity Type:Organization
Organization Name:INTERMOUNTAIN HOME HEALTH INC
Other - Org Name:SUMMIT HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BRITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:801-542-7150
Mailing Address - Street 1:5882 S 900 E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1683
Mailing Address - Country:US
Mailing Address - Phone:801-542-7150
Mailing Address - Fax:801-542-7154
Practice Address - Street 1:5882 S 900 E
Practice Address - Street 2:SUITE 101
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-1683
Practice Address - Country:US
Practice Address - Phone:801-542-7150
Practice Address - Fax:801-542-7154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2006-HHA-72612251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT467223Medicare ID - Type UnspecifiedHOME HEALTH