Provider Demographics
NPI:1932202421
Name:ALPINE HOME HEALTH LLC
Entity Type:Organization
Organization Name:ALPINE HOME HEALTH LLC
Other - Org Name:ALPINE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:BREINHOLT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-486-2348
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:801-486-2348
Mailing Address - Fax:801-486-2380
Practice Address - Street 1:1970 S 200 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-2402
Practice Address - Country:US
Practice Address - Phone:801-486-2348
Practice Address - Fax:801-486-2380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT206-HHA-775251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT879547967000Medicaid
UT=========004Medicaid
UT=========004Medicaid