Provider Demographics
NPI:1336545128
Name:ROCKY MOUNTAIN PERSONAL CARE LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN PERSONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:JAUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-397-4054
Mailing Address - Street 1:576 W 900 S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8194
Mailing Address - Country:US
Mailing Address - Phone:801-397-4054
Mailing Address - Fax:801-397-4196
Practice Address - Street 1:576 W 900 S
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODS CROSS
Practice Address - State:UT
Practice Address - Zip Code:84010-8194
Practice Address - Country:US
Practice Address - Phone:801-397-4054
Practice Address - Fax:801-397-4196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2014-PCA-UT000614253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000091220Medicare Oscar/Certification