Independence Home Care, LLC
Organization Active NPI Community Based Hospice Care Agency · North Ogden, UT
NPI 1235470337 · NPPES record last updated Apr 25, 2024
Key facts
- NPI
- 1235470337
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- INDEPENDENCE HOME CARE, LLC
- Practice address
- 800 E. 2600 N.
North Ogden, UT 84414 - Phone
- (801) 298-1100
- Fax
- (801) 298-1988
- NPI assigned
- Mar 14, 2013
- Organization subpart
- No
Authorized official
- Name
- Johnson T Webb
- Title
- Managing Partner
- Phone
- (801) 698-9874
Other NPIs with the same Medicare PAC ID 1
Facilities with the same owner 1
Practitioners 2
-
Michelle Lynn Lewis, DNP, AGNP-C
Affiliated clinicians 2
-
Marcia Pinkerman, DNP, FNP-C
Medicare Care Compare: Hospice
- Listed as
- Independence Hospice
- Ownership
- For-Profit
- Certified
- May 25, 2011
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Hospice certification: CCN 461585
- Legal name
- INDEPENDENCE HOME CARE LLC
- Doing business as
- INDEPENDENCE HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- May 25, 2011
- Last certification
- Dec 4, 2019
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- LLC · Proprietary
- Incorporated
- Aug 9, 2011 in UT
- Enrollment address
- 707 W 700 S
Ste 201
Woods Cross, UT 84087-1458
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Pinnacle Health Services Inc |
Operational/Managerial Control | Mar 16, 2015 | 100% |
| Independence Home Care Holdings LLC |
5% Or Greater Direct Ownership Interest | Jan 12, 2023 | 100% |
| Michael Schefer |
5% Or Greater Indirect Ownership Interest |
Jan 12, 2023 | |
| Corporate Director |
Jan 12, 2023 | ||
| Johnson Webb |
5% Or Greater Indirect Ownership Interest | Mar 5, 2023 | 66.6% |
| Corporate Officer | Jan 12, 2023 | ||
| Corporate Director |
Jan 12, 2023 | ||
| W-2 Managing Employee |
Jan 12, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150504000416 | UT | Part a Provider - Hospice | 2668637125 | Practice locations: Woods Cross, UT |
National Provider Directory
Locations
640 S 500 W
Bountiful, UT 84010
Phone (208) 238-0088
707 W 700 S
Ste 201
Woods Cross, UT 84087
Phone (801) 298-1100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
800 E. 2600 N.
North Ogden, UT 84414
Mailing address
800 E. 2600 N.
North Ogden, UT 84414
Phone (801) 298-1100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3000825 | Medicaid | UT |
Other names
- Independence Hospice
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 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.