Organization
CARESOURCE
Active
Other names
CareSource Home Health and Hospice
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHAWNTEL ELIZABETH TANNER MA (CEO/ADMINISTRATOR)
(801) 266-7200
Entity
Organization
Contact information
Practice address
750 KEARNS BLVD. #200, PARK CITY, UT 84060
(801) 266-7200
(801) 266-7004
Mailing address
PO BOX 680839, 750 KEARNS BLVD. #200, PARK CITY, UT 84068
(801) 266-7200
(801) 266-7004
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
2006-HHA-912
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HT005376-001
TRADING PARTNER NUMBER
UT
Enumeration date
04/18/2006
Last updated
11/14/2016
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