Provider Demographics
NPI:1780178343
Name:IDEAL IV THERAPY AND HOME CARE
Entity type:Organization
Organization Name:IDEAL IV THERAPY AND HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:801-870-9985
Mailing Address - Street 1:11433 S MOUNTAIN RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-5647
Mailing Address - Country:US
Mailing Address - Phone:801-870-9985
Mailing Address - Fax:
Practice Address - Street 1:11433 S MOUNTAIN RIDGE CIR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-5647
Practice Address - Country:US
Practice Address - Phone:801-870-9985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT342765-3102251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care