Provider Demographics
NPI:1730254160
Name:IHC HEALTH SERVICES INC
Entity type:Organization
Organization Name:IHC HEALTH SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP-HOMECARE HOSPICE PALLIATIVE CARE
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PROVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-442-2000
Mailing Address - Street 1:11520 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-7805
Mailing Address - Country:US
Mailing Address - Phone:385-887-6000
Mailing Address - Fax:801-442-0603
Practice Address - Street 1:3776 WALL AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-7103
Practice Address - Country:US
Practice Address - Phone:801-399-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTHHA-141251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1730254160Medicaid
UT870405177005Medicaid
UT467004Medicare Oscar/Certification