Provider Demographics
NPI:1902378417
Name:1 ASSIST CARE OF UTAH VALLEY LLC
Entity Type:Organization
Organization Name:1 ASSIST CARE OF UTAH VALLEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:RAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-557-4215
Mailing Address - Street 1:3965 W 2000 S
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-4012
Mailing Address - Country:US
Mailing Address - Phone:208-557-4215
Mailing Address - Fax:888-384-0874
Practice Address - Street 1:180 N UNIVERSITY AVENUE
Practice Address - Street 2:SUITE 270, OFFICE 213
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601
Practice Address - Country:US
Practice Address - Phone:801-852-0072
Practice Address - Fax:888-384-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care