Provider Demographics
NPI:1023265451
Name:ANGELS CROSSING HOME HOSPICE PLLC
Entity type:Organization
Organization Name:ANGELS CROSSING HOME HOSPICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAILE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:TAVAKE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:801-428-1060
Mailing Address - Street 1:2480 S MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-3058
Mailing Address - Country:US
Mailing Address - Phone:801-428-1060
Mailing Address - Fax:801-855-5908
Practice Address - Street 1:2480 S MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-3058
Practice Address - Country:US
Practice Address - Phone:801-428-1060
Practice Address - Fax:801-855-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient