Provider Demographics
NPI:1558307595
Name:VALI DIVISION OF WASATCH, INC
Entity Type:Organization
Organization Name:VALI DIVISION OF WASATCH, INC
Other - Org Name:ROCKY MOUNTAIN HOSPICE - ST. GEORGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BANGERTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-397-4100
Mailing Address - Street 1:350 E 300 S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4914
Mailing Address - Country:US
Mailing Address - Phone:801-397-4100
Mailing Address - Fax:801-397-4195
Practice Address - Street 1:230 NORTH 1680 EAST
Practice Address - Street 2:SUITE V-1
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-673-6699
Practice Address - Fax:435-656-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005-HOSPICE-830251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========002Medicaid
UT461570Medicare Oscar/Certification