Provider Demographics
NPI:1598749798
Name:AXIS IN-HOME, INC.
Entity Type:Organization
Organization Name:AXIS IN-HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-608-3882
Mailing Address - Street 1:754 TECHNOLOGY AVE STE F11-20
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-6204
Mailing Address - Country:US
Mailing Address - Phone:801-608-3882
Mailing Address - Fax:801-576-7536
Practice Address - Street 1:754 TECHNOLOGY AVE STE F11-20
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-6204
Practice Address - Country:US
Practice Address - Phone:801-608-3882
Practice Address - Fax:801-576-7536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2004-HHA-42117251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT467207Medicare ID - Type Unspecified