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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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