Provider Demographics
NPI:1760705032
Name:UTAH HOME HEALTH AND HOSPICE LLC
Entity Type:Organization
Organization Name:UTAH HOME HEALTH AND HOSPICE LLC
Other - Org Name:UTAH HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-373-1400
Mailing Address - Street 1:PO BOX 1052
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84603-1052
Mailing Address - Country:US
Mailing Address - Phone:801-373-1400
Mailing Address - Fax:801-377-2386
Practice Address - Street 1:362 W CENTER ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4659
Practice Address - Country:US
Practice Address - Phone:801-373-1400
Practice Address - Fax:801-377-2386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT=========002Medicaid
UT467225Medicare PIN