Provider Demographics
NPI:1336413285
Name:DIGNITY HOSPICE OF UTAH
Entity Type:Organization
Organization Name:DIGNITY HOSPICE OF UTAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-492-4892
Mailing Address - Street 1:174 S 1100 E
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2817
Mailing Address - Country:US
Mailing Address - Phone:801-492-4892
Mailing Address - Fax:801-770-3322
Practice Address - Street 1:174 S 1100 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2817
Practice Address - Country:US
Practice Address - Phone:801-492-4892
Practice Address - Fax:801-770-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT461601Medicare Oscar/Certification