Organization
SKOUT SOURCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN PETERSON (MANAGING MEMBER)
(949) 556-5377
Entity
Organization
Contact information
Practice address
6955 S UNION PARK CTR STE 200, COTTONWOOD HEIGHTS, UT 84047-6514
(877) 467-5688
Mailing address
6955 S UNION PARK CTR STE 200, COTTONWOOD HEIGHTS, UT 84047-6514
(877) 467-5688
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
Other
Enumeration date
03/31/2022
Last updated
03/31/2022
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