Provider Demographics
NPI:1811147754
Name:SILVERADO AT HOME
Entity type:Organization
Organization Name:SILVERADO AT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR SLC AT HOME
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALLRED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-262-3389
Mailing Address - Street 1:855 EAST 4800 SOUTH
Mailing Address - Street 2:STE 240
Mailing Address - City:SLC MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-262-3389
Mailing Address - Fax:801-262-1605
Practice Address - Street 1:855 EAST 4800 SOUTH
Practice Address - Street 2:STE 240
Practice Address - City:SLC MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-262-3389
Practice Address - Fax:801-262-1605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SILVERADO SL/CT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2008HHA85506251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health