Provider Demographics
NPI:1558745984
Name:HOME CAREGIVERS PARTNERSHIP LLC
Entity Type:Organization
Organization Name:HOME CAREGIVERS PARTNERSHIP LLC
Other - Org Name:CANYON HOME CARE OF SOUTHERN UTAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADIMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-485-6166
Mailing Address - Street 1:450 S 900 E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2981
Mailing Address - Country:US
Mailing Address - Phone:801-485-6166
Mailing Address - Fax:801-531-1949
Practice Address - Street 1:1240 E 100 S
Practice Address - Street 2:SUITE 119
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-3001
Practice Address - Country:US
Practice Address - Phone:435-773-9982
Practice Address - Fax:435-773-9982
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOME CAREGIVERS PARTNERSHIP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2015-HHA-UT000585251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT467340Medicare PIN