Provider Demographics
NPI:1013996768
Name:TOOELE HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:TOOELE HOME CARE SERVICES LLC
Other - Org Name:MOUNTAIN WEST HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OFFICE SUPPORT
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:1887 NORTH AARON DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-8138
Mailing Address - Country:US
Mailing Address - Phone:435-882-4163
Mailing Address - Fax:435-882-7821
Practice Address - Street 1:1887 NORTH AARON DR
Practice Address - Street 2:SUITE D
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-8138
Practice Address - Country:US
Practice Address - Phone:435-882-4163
Practice Address - Fax:435-882-7821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005-HHA-14227251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT467054Medicare Oscar/Certification