Provider Demographics
NPI:1942621602
Name:ROCKY MOUNTAIN PERSONAL CARE LLC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN PERSONAL CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
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 1:5242 S COLLEGE DR
Mailing Address - Street 2:STE 340
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2653
Mailing Address - Country:US
Mailing Address - Phone:801-397-4000
Mailing Address - Fax:
Practice Address - Street 1:576 W 900 S
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODS CROSS
Practice Address - State:UT
Practice Address - Zip Code:84010-8194
Practice Address - Country:US
Practice Address - Phone:801-397-4054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-26
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT46D2076467OtherCLIA NUMBER
2014-HHA-UT000638OtherSTATE HOME HEALTH AGENCY NUMBER
UT2014-PCA-UT000614OtherSTATE PERSONAL CARE LICENSE NUMBER