NPIMap

Organization Active NPI

Good Shepherd Homecare and Hospice of Eastern Utah, Inc.

  • Home Health Agency
  • Vernal, UT
National Provider Identifier
1184820854
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
467237 Issued in UT
Legal business name
GOOD SHEPHERD HOMECARE AND HOSPICE OF EASTERN UTAH, INC.
Practice address
266 W 100 N
Ste 2
Vernal, UT 84078
Phone
(435) 789-0499
Fax
(435) 789-0498
NPI assigned
Jun 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Walter M Matjasich
Title
Administrator
Phone
(801) 277-6474

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 467237 UT Primary

Addresses

Primary practice location

266 W 100 N
Ste 2
Vernal, UT 84078

Mailing address

3584 W 9000 S Ste 300
West Jordan, UT 84088-5711
Phone (801) 277-6474

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060124000770 UT Part A Provider - Home Health Agency 6204850654 Practice locations: Vernal, UT; West Jordan, UT

Home health agency certification: CCN 467237

Legal name
GOOD SHEPHERD HOMECARE AND HOSPICE OF EASTERN UTAH, INC.
Doing business as
GOOD SHEPHERD HOME CARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
May 18, 2007
Last certification
Apr 24, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Dec 7, 2005 in UT
Enrollment address
1680 W Highway 40
Ste 104
Vernal, UT 84078-4142

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Good Shepherd Home CareCCN 467237 ยท All quality measures
Overall star rating
3 of 5
Ownership
Proprietary
Certified
May 18, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Good Shepherd Homecare and Hospice of Eastern Utah Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1680 W Highway 40
Ste 104
Vernal, UT 84078
Phone (435) 789-0499

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Walter Michael Matjasich Individual 5% Or Greater Direct Ownership Interest Nov 8, 2005 33.33%
Corporate OfficerVP, Administrator Dec 7, 2005
Corporate DirectorMember of the Board of Directors Dec 7, 2005
W-2 Managing EmployeeAdministrator Nov 8, 2005
Operational/Managerial ControlAdministrator, Member of the Boa Dec 7, 2005
Scott C Jolley Individual 5% Or Greater Direct Ownership Interest Nov 8, 2005 33.34%
Corporate OfficerPresident Nov 8, 2005
Corporate DirectorPresident Nov 8, 2005
W-2 Managing EmployeePresident Nov 8, 2005
Operational/Managerial ControlPresident Dec 7, 2005
John Farley Sowards Individual 5% Or Greater Direct Ownership Interest Nov 8, 2005 33.33%
Corporate OfficerVP of Business Development Dec 7, 2005 33.3%
Corporate DirectorVP of Business Development Dec 7, 2005 33.3%
W-2 Managing EmployeeVP of Business Development Nov 8, 2005 33.3%
Operational/Managerial ControlVP of Business Development Dec 7, 2005 33.3%

Practitioners & affiliated clinicians

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684195200000",
    "number": "1184820854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3584 W 9000 S STE 300",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840885711",
            "telephone_number": "801-277-6474",
            "fax_number": "877-789-0498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "266 W 100 N",
            "address_2": "STE 2",
            "city": "VERNAL",
            "state": "UT",
            "postal_code": "84078",
            "telephone_number": "435-789-0499",
            "fax_number": "435-789-0498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD HOMECARE AND HOSPICE OF EASTERN UTAH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-21",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A",
        "authorized_official_last_name": "MATJASICH",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "801-277-6474"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "UT",
            "license": "467237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vernal, UT

Sources for this page

Verify at the official NPI Registry.