Provider Demographics
NPI:1205194222
Name:INDEPENDENCE HOME CARE, LLC
Entity type:Organization
Organization Name:INDEPENDENCE HOME CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNSON
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-698-9974
Mailing Address - Street 1:800 E 2600 N
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-2436
Mailing Address - Country:US
Mailing Address - Phone:801-698-9974
Mailing Address - Fax:801-447-9240
Practice Address - Street 1:182 N UNION AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2907
Practice Address - Country:US
Practice Address - Phone:801-698-8927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health