Provider Demographics
NPI:1902185952
Name:WASATCH REGIONAL HOSPICE
Entity Type:Organization
Organization Name:WASATCH REGIONAL HOSPICE
Other - Org Name:AEGIS HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-628-4575
Mailing Address - Street 1:2974 W 3500 S
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-3630
Mailing Address - Country:US
Mailing Address - Phone:801-849-0696
Mailing Address - Fax:801-542-0078
Practice Address - Street 1:2974 W 3500 S
Practice Address - Street 2:SUITE 600
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-3630
Practice Address - Country:US
Practice Address - Phone:801-849-0696
Practice Address - Fax:801-542-0078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based