Provider Demographics
NPI:1265430573
Name:ALPINE HOSPICE INC
Entity type:Organization
Organization Name:ALPINE HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:BREINHOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-392-8880
Mailing Address - Street 1:PO BOX 65788
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84165-0788
Mailing Address - Country:US
Mailing Address - Phone:801-392-8880
Mailing Address - Fax:801-395-2498
Practice Address - Street 1:990 W 5370 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123-5435
Practice Address - Country:US
Practice Address - Phone:801-486-2348
Practice Address - Fax:801-466-8961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT461528Medicare ID - Type Unspecified