Provider Demographics
NPI:1366558884
Name:HOSPICE ALLIANCE, INC.
Entity type:Organization
Organization Name:HOSPICE ALLIANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-753-0707
Mailing Address - Street 1:965 S 100 W
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6062
Mailing Address - Country:US
Mailing Address - Phone:435-753-0707
Mailing Address - Fax:435-755-8505
Practice Address - Street 1:1255 E 3900 S
Practice Address - Street 2:SUITE 105
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1334
Practice Address - Country:US
Practice Address - Phone:801-261-8437
Practice Address - Fax:801-261-5463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT461551Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER