Provider Demographics
NPI:1831666817
Name:AUBURN CREST HOME HEALTH UTAH, LLC
Entity Type:Organization
Organization Name:AUBURN CREST HOME HEALTH UTAH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-376-7298
Mailing Address - Street 1:PO BOX 1176
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83680-1176
Mailing Address - Country:US
Mailing Address - Phone:208-376-7298
Mailing Address - Fax:208-377-8310
Practice Address - Street 1:12244 S BUSINESS PARK DR STE 215
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-6561
Practice Address - Country:US
Practice Address - Phone:801-687-1746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health