Provider Demographics
NPI:1932982691
Name:UTAH PEDIATRIC HOMECARE LLC
Entity Type:Organization
Organization Name:UTAH PEDIATRIC HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BARSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:801-362-2631
Mailing Address - Street 1:3038 S SPECIALTY CIR STE 202
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-3479
Mailing Address - Country:US
Mailing Address - Phone:801-362-2631
Mailing Address - Fax:801-852-0366
Practice Address - Street 1:3038 S SPECIALTY CIR STE 202
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-3479
Practice Address - Country:US
Practice Address - Phone:801-362-2631
Practice Address - Fax:801-852-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health