Provider Demographics
NPI:1902044563
Name:MOUNTAIN REGION HOSPICE & HOMECARE, LLC
Entity Type:Organization
Organization Name:MOUNTAIN REGION HOSPICE & HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-573-1221
Mailing Address - Street 1:106 W 500 S
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6203
Mailing Address - Country:US
Mailing Address - Phone:801-335-0522
Mailing Address - Fax:801-335-0523
Practice Address - Street 1:106 W 500 S
Practice Address - Street 2:SUITE 103
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6203
Practice Address - Country:US
Practice Address - Phone:801-335-0522
Practice Address - Fax:801-335-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2010-HOSPICE-92677251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT461585Medicare Oscar/Certification