Specialty Nursing Services
Organization
Active NPI
Home Health Agency · Huntsville, UT
NPI 1144223249 · NPPES record last updated Feb 29, 2024
Key facts
- NPI
- 1144223249
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 2004-HHA-844 (UT)
- Legal business name
- SPECIALTY NURSING SERVICES
- Practice address
- 620 S 9500 E
Huntsville, UT 84317
- Phone
- (801) 732-2178
- Fax
- (801) 732-2173
- NPI assigned
- May 23, 2005
- Organization subpart
- No
Authorized official
- Name
- Tawshawni Butcher
- Title
- Offlce Manager
- Phone
- (801) 732-2168
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
Deseret Day Allen, DNP, APRN, FNP-BC
Family Nurse Practitioner · Layton, UT · NPI 1891369732
Affiliated clinicians 7
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
Brittney Andersen, APRN
Nurse Practitioner · Draper, UT · NPI 1174831408
-
Amy Jo Fowers, FNP
Family Nurse Practitioner · West Haven, UT · NPI 1407432933
-
Alyxandria Gonzales Family Nurse Practitioner · West Haven, UT · NPI 1659053924
-
Gary F Holland, MD
Family Medicine Physician · Kaysville, UT · NPI 1780780189
-
Andrea Marie Martinez, NP-C
Family Nurse Practitioner · Murray, UT · NPI 1417427626
-
Tyler Mark Nixon, DO
Internal Medicine Physician · Layton, UT · NPI 1669639985
-
Adam Russell Physician Assistant · Henderson, NV · NPI 1063247583
Medicare Care Compare: Home health agency
- Listed as
- Specialty Nursing Services CCN 467110
- Ownership
- Proprietary
- Certified
- Feb 18, 1997
- Medicare certification status
- Active (Provider of Services file)
- Services
- Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Source: Medicare Care Compare.
Laboratory certificates & supplier records
Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|
| 46D0925016 | Specialty Nursing Services
620 S 9500 E, Huntsville, UT 84317 | Certificate of waiver | Feb 12, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Home health agency certification: CCN 467110
- Legal name
- SPECIALTY NURSING SERVICES
- Doing business as
- SPECIALTY NURSING SERVICES
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Feb 18, 1997
- Last certification
- Sep 18, 2019
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Proprietary
- Incorporated
- Jun 8, 2022 in UT
- Enrollment address
- 620 S 9500 E
Huntsville, UT 84317-9748
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|
Cynthia Allen
Individual
|
W-2 Managing Employee
Administrator |
Oct 26, 2022 |
|
Jacob Stein
Individual
|
5% Or Greater Direct Ownership Interest |
Oct 15, 2022 |
100% |
Change-of-ownership history
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| O20221014002637 |
UT |
Part a Provider - Home Health Agency |
9537535596 |
Practice locations: Huntsville, UT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Home Health Agency |
251E00000X |
2004-HHA-844 |
UT |
Yes |
| Clinical Medical Laboratory |
291U00000X |
46D0925016 |
UT |
|
Addresses
Primary practice location
620 S 9500 E
Huntsville, UT 84317
Mailing address
620 S 9500 E
Huntsville, UT 84317
Phone (801) 732-2178
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 467110 | Other | | MEDICARE OSCAR NUMBER |
Other names
- Specialty Nursing Services INC Former legal business name
- Specialty Nursing Services Home Health LLC Other name
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.
Verify at the official NPI Registry.