Provider Demographics
NPI:1932633997
Name:PALLIATIVE CARE FOR UTAH LLC
Entity Type:Organization
Organization Name:PALLIATIVE CARE FOR UTAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:NEBEKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-524-0685
Mailing Address - Street 1:5097 S 900 E STE 100
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5725
Mailing Address - Country:US
Mailing Address - Phone:801-576-1455
Mailing Address - Fax:801-576-1472
Practice Address - Street 1:5097 S 900 E STE 100
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84117-5725
Practice Address - Country:US
Practice Address - Phone:801-576-1455
Practice Address - Fax:801-576-1472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care