Provider Demographics
NPI:1487333241
Name:CONNECTED SENIOR CARE LLC
Entity type:Organization
Organization Name:CONNECTED SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHASE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-890-8542
Mailing Address - Street 1:3888 S 4000 W
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84339-8401
Mailing Address - Country:US
Mailing Address - Phone:435-554-8688
Mailing Address - Fax:
Practice Address - Street 1:95 W 100 S STE 118
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5182
Practice Address - Country:US
Practice Address - Phone:435-554-8688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care