Organization
AT HOME CARE AND HEALTH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ASHLYN TEED OWNER (ADMINISTRATOR)
(435) 256-0867
Entity
Organization
Contact information
Practice address
639 S 315 E, IVINS, UT 84738-5054
(435) 256-0867
(435) 652-3675
Mailing address
639 S 315 E, IVINS, UT 84738-5054
(435) 256-0867
(435) 652-3675
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
2016-PCA-UT000780
UT
347C00000X
Private Vehicle
2016-PCA-UT000780
UT
385H00000X
Respite Care
2016-PCA-UT000780
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1700331162
MOLINA
UT
05
—
1700331162
—
UT
Enumeration date
02/13/2017
Last updated
05/08/2017
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