Provider Demographics
NPI:1659505501
Name:HOSPICE CARE OF NORTHERN UTAH, LLC
Entity Type:Organization
Organization Name:HOSPICE CARE OF NORTHERN UTAH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, CHPN
Authorized Official - Phone:801-689-3049
Mailing Address - Street 1:2721 N HWY 89
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84404-6258
Mailing Address - Country:US
Mailing Address - Phone:801-689-3049
Mailing Address - Fax:801-689-3045
Practice Address - Street 1:2721 N HWY 89
Practice Address - Street 2:SUITE 200
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84404-6258
Practice Address - Country:US
Practice Address - Phone:801-689-3049
Practice Address - Fax:801-689-3045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1015860251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based