Provider Demographics
NPI:1922536242
Name:JON AND NICOLE WOOLSEY
Entity Type:Organization
Organization Name:JON AND NICOLE WOOLSEY
Other - Org Name:RIGHT AT HOME OF DAVIS AND WEBER COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN TASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-479-7026
Mailing Address - Street 1:1496 EAST 5600 SOUTH #6
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1496 E 5600 S STE 6
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4824
Practice Address - Country:US
Practice Address - Phone:801-479-7026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT2017-PCA-UT000382Medicaid