Provider Demographics
NPI:1972045227
Name:DIVERSIFIED HOME CARE LLC
Entity Type:Organization
Organization Name:DIVERSIFIED HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:N
Authorized Official - Last Name:WINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-635-9619
Mailing Address - Street 1:10757 S RIVER FRONT PKWY
Mailing Address - Street 2:110
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3545
Mailing Address - Country:US
Mailing Address - Phone:801-635-9619
Mailing Address - Fax:
Practice Address - Street 1:10757 S RIVER FRONT PKWY
Practice Address - Street 2:110
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3545
Practice Address - Country:US
Practice Address - Phone:801-635-9619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No347C00000XTransportation ServicesPrivate Vehicle