Provider Demographics
NPI:1770665010
Name:BURCHCREEK HOMECARE & HOSPICE, LLC
Entity Type:Organization
Organization Name:BURCHCREEK HOMECARE & HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:801-452-6066
Mailing Address - Street 1:1496 E 5600 S
Mailing Address - Street 2:STE 4
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4565
Mailing Address - Country:US
Mailing Address - Phone:801-452-6066
Mailing Address - Fax:
Practice Address - Street 1:1496 E 5600 S
Practice Address - Street 2:STE 4
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4565
Practice Address - Country:US
Practice Address - Phone:801-452-6066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========OtherEIN
UT467246Medicare PIN