Provider Demographics
NPI:1932110046
Name:DIGNITY HOME HEALTH, LLC
Entity Type:Organization
Organization Name:DIGNITY HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRICE
Authorized Official - Middle Name:N
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:II
Authorized Official - Credentials:MBA
Authorized Official - Phone:801-492-4892
Mailing Address - Street 1:62 N GRANT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-1728
Mailing Address - Country:US
Mailing Address - Phone:801-492-4892
Mailing Address - Fax:801-770-3322
Practice Address - Street 1:62 N GRANT AVE STE 100
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-1728
Practice Address - Country:US
Practice Address - Phone:801-492-4892
Practice Address - Fax:801-770-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT=========002OtherMEDICAID AGING WAIVER
UT467233Medicare Oscar/Certification