Provider Demographics
NPI:1891455895
Name:HOME CLINIX UTAH LLC
Entity Type:Organization
Organization Name:HOME CLINIX UTAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-822-1880
Mailing Address - Street 1:39 PIER PL
Mailing Address - Street 2:
Mailing Address - City:STANSBURY PK
Mailing Address - State:UT
Mailing Address - Zip Code:84074-4918
Mailing Address - Country:US
Mailing Address - Phone:801-822-1880
Mailing Address - Fax:801-890-3434
Practice Address - Street 1:39 PIER PL
Practice Address - Street 2:
Practice Address - City:STANSBURY PK
Practice Address - State:UT
Practice Address - Zip Code:84074-4918
Practice Address - Country:US
Practice Address - Phone:801-822-1880
Practice Address - Fax:801-890-3434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-19
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Multi-Specialty