| Organization Name: | PINE MOUNTAIN HOME HEALTH, LLC |
| NPI Number: | 1053746594 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TRACE D. OSBORNE (ACCOUNTANT) |
| Mailing Address: | 1244 N Main St Suite 103 Tooele |
| State: | UT US |
| Postal Code: | 840749838 |
| Phone Number: | 4352480771 |
| Fax Number: | 4352480777 |
| NPI Enumeration Date: | 09/03/2013 |
| NPI Last Update Date: | 02/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |