Provider Demographics
NPI:1497221618
Name:SENIOR HEALTH LLC
Entity type:Organization
Organization Name:SENIOR HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGERTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-397-4101
Mailing Address - Street 1:598 W 900 S STE 230
Mailing Address - Street 2:
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8195
Mailing Address - Country:US
Mailing Address - Phone:801-397-4040
Mailing Address - Fax:801-397-4190
Practice Address - Street 1:598 W 900 S STE 230
Practice Address - Street 2:
Practice Address - City:WOODS CROSS
Practice Address - State:UT
Practice Address - Zip Code:84010-8195
Practice Address - Country:US
Practice Address - Phone:801-397-4040
Practice Address - Fax:801-397-4190
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENIOR HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-15
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333300000XSuppliersEmergency Response System CompaniesGroup - Single Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========Medicaid