Provider Demographics
NPI:1174520027
Name:UNITED HOMECARE OF NORTHERN CALIFORNIA, LC
Entity type:Organization
Organization Name:UNITED HOMECARE OF NORTHERN CALIFORNIA, LC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BANGERTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-397-4000
Mailing Address - Street 1:598 W 900 S STE 220
Mailing Address - Street 2:
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8195
Mailing Address - Country:US
Mailing Address - Phone:801-397-4697
Mailing Address - Fax:801-296-9117
Practice Address - Street 1:245 NEW YORK RANCH RD
Practice Address - Street 2:STE C
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2147
Practice Address - Country:US
Practice Address - Phone:209-223-3866
Practice Address - Fax:209-223-3882
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKY MOUNTAIN HOME HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-07
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100000267251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ036772OtherBLUE SHIELD OF CALIFORNIA
CAHHA07801HMedicaid
CAHHA07801HMedicaid