NPIMap

Organization Active NPI

Ihc Health Services Inc

  • Community Based Hospice Care Agency
  • Logan, UT
National Provider Identifier
1245305689
Registry record updated Jan 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
IHC HEALTH SERVICES INC
Practice address
550 E 1400 N Ste G
Logan, UT 84341-2450
Phone
(435) 716-5477
NPI assigned
Nov 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2025

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

Authorized official

Name
Mark Provan
Title
VP-Homecare Hospice Palliative Care
Phone
(801) 442-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

550 E 1400 N Ste G
Logan, UT 84341-2450

Mailing address

11520 S Redwood Rd
South Jordan, UT 84095-7805
Phone (385) 887-6000

Other identifiers 1

IdentifierTypeStateIssuer
1245305689MedicaidUT

Other names 1

  • Intermountain Health Hospice Logan Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091117000514 UT Part A Provider - Hospice 1850209420 Practice locations: Logan, UT

Hospice certification: CCN 461504

Legal name
IHC HEALTH SERVICES INC
Doing business as
INTERMOUNTAIN HEALTH HOSPICE - LOGAN
Certification status
Active
Provider type (POS)
Hospice
Participating since
May 26, 1993
Last certification
Jun 8, 2022
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1982 in UT
Enrollment address
550 E 1400 N
Ste G
Logan, UT 84341-2450

Care Compare: Hospice

Medicare Care Compare
Listed as
Intermountain Homecare Hospice of LoganCCN 461504
Ownership
Non-Profit
Certified
May 26, 1993
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D1101263Intermountain Health Hospice - Logan550 East 1400 North Ste G, Logan, UT 84341Certificate of waiverJun 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Bradley S Thompson DO479 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

175 N Main St
Ste 103
Heber City, UT 84032
Phone (435) 657-4323

550 E 1400 N
Ste G
Logan, UT 84341
Phone (435) 716-5477

3776 Wall Ave
Ogden, UT 84405
Phone (385) 333-5339

524 W 300 N
Ste 101
Provo, UT 84601
Phone (801) 225-0584

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Shannon Cooke Baker Individual Corporate DirectorTrustee Jun 1, 2024
Ihc Health Services Inc Organization, Salt Lake City, UT Non-profit 5% Or Greater Direct Ownership Interest Oct 1, 2009 100%
Robert Pettitt Individual Corporate DirectorTrustee Jun 7, 2023
Elizabeth Owens Individual Corporate DirectorTrustee Jun 1, 2024
William Caine Individual Corporate DirectorTrustee Jun 7, 2023
Patricia Ricks Individual Corporate DirectorTrustee Jun 1, 2024
Susan Robel Individual Corporate DirectorTrustee Apr 1, 2022
Deirdra Walsh Individual Corporate DirectorTrustee Jun 7, 2023
Robert Spendlove Individual Corporate DirectorTrustee Jun 1, 2024
Matt C Packard Individual Corporate DirectorBoard Member Jul 27, 2016
Riley Watts Individual Corporate OfficerFinance Director Sep 16, 2024
W-2 Managing EmployeeFinance Director Sep 16, 2024
Mark Provan Individual Corporate OfficerVP Homecare, Hospice, Palliative Ca Nov 13, 2023
Patricia K Ravert Individual Corporate DirectorBoard Member Oct 8, 2017
William Hulterstrom Individual Corporate DirectorTrustee Jun 7, 2023
Robert W Allen Individual Corporate DirectorCeo Dec 1, 2022

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 43

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Intermountain Health Cedar City HospitalCedar City, UT, CCN 460007 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1981
Mountain View HospitalIdaho Falls, ID, CCN 130065 Hospital 5% Or Greater Direct Ownership Interest (15%) Mar 31, 2023
Intermountain Health St George Regional HospitalSt George, UT, CCN 460021 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Intermountain Health McKay-Dee HospitalOgden, UT, CCN 460004 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 1976
Jan 1, 1976
Intermountain Health Sevier Valley HospitalRichfield, UT, CCN 460026 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1976
Intermountain Health Bear River Valley HospitalTremonton, UT, CCN 460039 Hospital 5% Or Greater Direct Ownership Interest Jul 5, 1995
Intermountain Health Logan Regional HospitalLogan, UT, CCN 460015 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1970
Intermountain Health Intermountain Medical CenterMurray, UT, CCN 460010 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Intermountain Health Alta View HospitalSandy, UT, CCN 460044 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 7, 1982
Intermountain Health American Fork HospitalAmerican Fork, UT, CCN 460023 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1970
Intermountain Health LDS HospitalSalt Lake City, UT, CCN 460006 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1970
Intermountain Health Orem Community HospitalOrem, UT, CCN 460043 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Intermountain Health Primary Children'S HospitalSalt Lake City, UT, CCN 463301 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1980
Intermountain Health Utah Valley HospitalProvo, UT, CCN 460001 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Intermountain Health Sanpete Valley HospitalMount Pleasant, UT, CCN 461303 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Intermountain Health Cassia Regional HospitalBurley, ID, CCN 131326 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Intermountain Health Delta Community HospitalDelta, UT, CCN 461300 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Intermountain Health Fillmore Community HospitalFillmore, UT, CCN 461301 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1970
Intermountain Health Heber Valley HospitalHeber City, UT, CCN 461307 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Delta Community HospitalDelta, UT, CCN 46Z300 Hospital 5% Or Greater Direct Ownership Interest (100%) Dec 29, 2008
Intermountain Health Fillmore Community HospitalFillmore, UT, CCN 46Z301 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 9, 2008
Heber Valley HospitalHeber City, UT, CCN 46Z307 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Apr 1, 1975
Apr 1, 1975
Intermountain Medical Center-RehabilitationMurray, UT, CCN 46T010 Hospital 5% Or Greater Direct Ownership Interest (100%) Aug 7, 2007
Ihc Health Services IncSt George, UT, CCN 46T021 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Apr 1, 1975
Jan 1, 1976
McKay Dee HospitalOgden, UT, CCN 46T004 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 1976
Jan 1, 1976
Intermountain Health St George Regional HospitalProvo, UT, CCN 46T001 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Sanpete Valley HospitalMt Pleasant, UT, CCN 46Z303 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Apr 1, 1975
Apr 1, 1975
Intermountain Health Park City HospitalPark City, UT, CCN 460057 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1970
Intermountain Health Riverton HospitalRiverton, UT, CCN 460058 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 2, 2009
Intermountain Health Garfield Memorial HospitalPanguitch, UT, CCN 461333 Hospital Operational/Managerial Control Jan 1, 2017
Intermountain Health Garfield Memorial HospitalPanguitch, UT, CCN 46Z333 Hospital Operational/Managerial Control Jul 1, 2000
Intermountain Health Layton HospitalLayton, UT, CCN 460061 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1970
Idaho Falls Community Hospital LLCIdaho Falls, ID, CCN 130074 Hospital 5% Or Greater Direct Ownership Interest (20%) Mar 31, 2023
Intermountain Health Spanish Fork HospitalSpanish Fork, UT, CCN 460062 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1970
Cassia Regional HospitalBurley, ID, CCN 13Z326 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Logan Regional Hospital Transitional Care UnitLogan, UT, CCN 465123 Skilled nursing facility Operational/Managerial Control Jul 29, 2008
Intermountain Health Home Health - Mt. PleasantMount Pleasant, UT, CCN 467016 Home health agency 5% Or Greater Direct Ownership Interest (100%) Aug 1, 1980
Intermountain Health Home Health - OgdenOgden, UT, CCN 467004 Home health agency 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1976
Intermountain Health Home Health - St. GeorgeSt George, UT, CCN 467033 Home health agency 5% Or Greater Direct Ownership Interest (100%) Mar 25, 2009
Garfield Memorial HospitalPanguitch, UT, CCN 463984 Rural health clinic Operational/Managerial Control Jan 21, 2010
Garfield CountyCircleville, UT, CCN 463980 Rural health clinic Operational/Managerial Control Apr 26, 2010
Bryce Valley ClinicCannonville, UT, CCN 463981 Rural health clinic Operational/Managerial Control Apr 26, 2010
Upper Valley FamilymedicineRigby, ID, CCN 138538 Rural health clinic 5% Or Greater Direct Ownership Interest Apr 7, 2025

Facilities with the same owner 31

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 31

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738108800000",
    "number": "1245305689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11520 S REDWOOD RD",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840957805",
            "telephone_number": "385-887-6000",
            "fax_number": "801-442-0603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 E 1400 N STE G",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412450",
            "telephone_number": "435-716-5477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IHC HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A",
        "authorized_official_last_name": "PROVAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "VP-HOMECARE HOSPICE PALLIATIVE CARE",
        "authorized_official_telephone_number": "801-442-2000"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245305689",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Intermountain Health Hospice Logan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Logan, UT

Sources for this page

Verify at the official NPI Registry.