Provider Demographics
NPI:1902801657
Name:ECLIPSE HOME HEALTH INC
Entity Type:Organization
Organization Name:ECLIPSE HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GOURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:801-293-1199
Mailing Address - Street 1:746 E WINCHESTER ST
Mailing Address - Street 2:G10
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8512
Mailing Address - Country:US
Mailing Address - Phone:801-293-1199
Mailing Address - Fax:801-293-1224
Practice Address - Street 1:746 E WINCHESTER ST
Practice Address - Street 2:G10
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-8512
Practice Address - Country:US
Practice Address - Phone:801-293-1199
Practice Address - Fax:801-293-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-18
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2004HHA35654251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========000Medicaid
UT467204Medicare ID - Type UnspecifiedHOME HEALTH AGENCY