Provider Demographics
NPI:1134550858
Name:HOSPICE ALLIANCE OF SOUTHERN UTAH, INC.
Entity type:Organization
Organization Name:HOSPICE ALLIANCE OF SOUTHERN UTAH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-753-3133
Mailing Address - Street 1:491 EAST RIVERDALE DR
Mailing Address - Street 2:#3B
Mailing Address - City:ST.GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7057
Mailing Address - Country:US
Mailing Address - Phone:435-656-2889
Mailing Address - Fax:435-656-2877
Practice Address - Street 1:491 E RIVERSIDE DR STE 3B
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7057
Practice Address - Country:US
Practice Address - Phone:435-656-2889
Practice Address - Fax:435-656-2877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT79732251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT461547Medicare Oscar/Certification