Organization
PROVIDENTIAL BBA OPERATING LP
Active
Organization
PROVIDENTIAL BBA OPERATING LP
Active
Other names
South Davis Hospice
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID A. BLAND (CEO)
(801) 397-8101
Entity
Organization
Contact information
Practice address
481 SOUTH 400 EAST, BOUNTIFUL, UT 84010-8401
(801) 295-2361
(801) 295-1398
Mailing address
401 SOUTH 400 EAST, BOUNTIFUL, UT 84010-4933
(801) 295-2361
(801) 295-1398
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
2006HOSPICE842
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215970835
—
UT
05
—
=========
—
UT
Enumeration date
06/13/2006
Last updated
06/24/2020
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