Provider Demographics
NPI:1760573836
Name:ADVANCED CARE HOME MEDICAL & OXYGEN, INC.
Entity Type:Organization
Organization Name:ADVANCED CARE HOME MEDICAL & OXYGEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:NORD
Authorized Official - Suffix:
Authorized Official - Credentials:RCP
Authorized Official - Phone:801-262-2210
Mailing Address - Street 1:6182 STRATLER ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6984
Mailing Address - Country:US
Mailing Address - Phone:801-262-2210
Mailing Address - Fax:801-265-9728
Practice Address - Street 1:6182 STRATLER ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6984
Practice Address - Country:US
Practice Address - Phone:801-262-2210
Practice Address - Fax:801-265-9728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTE17545332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========OtherBLUE CROSS BLUE SHIELD
UT=========006Medicaid
UT=========OtherBLUE CROSS BLUE SHIELD