Provider Demographics
NPI:1902170822
Name:ALLAY HOSPICE
Entity Type:Organization
Organization Name:ALLAY HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-649-4929
Mailing Address - Street 1:681 VISTA VIEW LN
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-2622
Mailing Address - Country:US
Mailing Address - Phone:801-649-4929
Mailing Address - Fax:
Practice Address - Street 1:681 VISTA VIEW LN
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-2622
Practice Address - Country:US
Practice Address - Phone:801-649-4929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based