Provider Demographics
NPI:1366915100
Name:ANGELS CROSSING HOSPICE AND HOME HEALTH
Entity type:Organization
Organization Name:ANGELS CROSSING HOSPICE AND HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:SIONE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-916-0918
Mailing Address - Street 1:2480 S MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-5005
Mailing Address - Country:US
Mailing Address - Phone:801-916-0918
Mailing Address - Fax:801-485-3750
Practice Address - Street 1:998074. TAFUNA VI.
Practice Address - Street 2:
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799
Practice Address - Country:US
Practice Address - Phone:684-254-7940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086H0002XAllopathic & Osteopathic PhysiciansSurgeryHospice and Palliative MedicineGroup - Single Specialty