Provider Demographics
NPI:1881022945
Name:FOUR BROTHERS HEALTH CARE,LLC
Entity Type:Organization
Organization Name:FOUR BROTHERS HEALTH CARE,LLC
Other - Org Name:FOUR CORNERS HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SLAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-874-4233
Mailing Address - Street 1:PO BOX 1929
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-1929
Mailing Address - Country:US
Mailing Address - Phone:801-874-4233
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 491, SUITE 15
Practice Address - Street 2:NAVAJO SHOPPING CENTER
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420
Practice Address - Country:US
Practice Address - Phone:801-874-4233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-28
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2T3441251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health