Organization
ROCKY MOUNTAIN PERSONAL CARE LLC
Active
Other names
Rocky Mountain Skilled Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEE R BANGERTER (CEO)
(801) 397-4000
Entity
Organization
Contact information
Practice address
576 W 900 S, SUITE 101, WOODS CROSS, UT 84010-8194
(801) 397-4054
Mailing address
5242 S COLLEGE DR, STE 340, SALT LAKE CITY, UT 84123-2653
(801) 397-4000
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2014-HHA-UT000638
STATE HOME HEALTH AGENCY NUMBER
—
01
—
2014-PCA-UT000614
STATE PERSONAL CARE LICENSE NUMBER
UT
01
—
46D2076467
CLIA NUMBER
UT
Enumeration date
12/26/2013
Last updated
05/18/2016
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