Provider Demographics
NPI:1821779497
Name:CANYON OGDEN HOME HEALTH LLC
Entity Type:Organization
Organization Name:CANYON OGDEN HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BREEZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LISKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-456-7874
Mailing Address - Street 1:450 S 900 E STE 100
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2983
Mailing Address - Country:US
Mailing Address - Phone:801-485-6166
Mailing Address - Fax:
Practice Address - Street 1:5926 FASHION POINT DR STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4713
Practice Address - Country:US
Practice Address - Phone:801-334-0904
Practice Address - Fax:801-334-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health