Provider Demographics
NPI:1558307793
Name:MILLCREEK HOME HEALTH
Entity Type:Organization
Organization Name:MILLCREEK HOME HEALTH
Other - Org Name:MILLCREEK HOME HEALTH AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EINAT
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:801-463-2478
Mailing Address - Street 1:1398 E LUCK LN
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2944
Mailing Address - Country:US
Mailing Address - Phone:801-463-2478
Mailing Address - Fax:801-486-0961
Practice Address - Street 1:1398 E LUCK LN
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2944
Practice Address - Country:US
Practice Address - Phone:801-463-2478
Practice Address - Fax:801-486-0961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2006HHA65754251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT467121Medicare ID - Type Unspecified