Provider Demographics
NPI:1619192242
Name:RED CANYON INC.
Entity Type:Organization
Organization Name:RED CANYON INC.
Other - Org Name:COMFORT KEEPERS OFFICE #166 & OFFICE #700
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CSA
Authorized Official - Phone:801-629-4663
Mailing Address - Street 1:2780 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-0112
Mailing Address - Country:US
Mailing Address - Phone:801-629-4663
Mailing Address - Fax:801-612-2273
Practice Address - Street 1:2780 MADISON AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-0112
Practice Address - Country:US
Practice Address - Phone:801-629-4663
Practice Address - Fax:801-612-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health