Provider Demographics
NPI:1912540683
Name:LUMICARE HEALTH UT1 LLC
Entity Type:Organization
Organization Name:LUMICARE HEALTH UT1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:RITTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-631-3944
Mailing Address - Street 1:2242 E SUADA DR
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1852
Mailing Address - Country:US
Mailing Address - Phone:801-631-3944
Mailing Address - Fax:
Practice Address - Street 1:2242 E SUADA DR
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84124-1852
Practice Address - Country:US
Practice Address - Phone:801-631-3944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based