Ihc Health Services Inc
Organization Active NPI Community Based Hospice Care Agency · South Jordan, UT
NPI 1720153711 · NPPES record last updated Jan 29, 2025
Key facts
- NPI
- 1720153711
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- IHC HEALTH SERVICES INC
- Practice address
- 11520 S Redwood Road
South Jordan, UT 84095 - Phone
- (385) 887-6000
- Fax
- (801) 442-0603
- NPI assigned
- Nov 22, 2006
- Organization subpart
- No
Authorized official
- Name
- Mark Provan
- Title
- VP-Homecare Hospice Palliative Care
- Phone
- (801) 442-2000
Owners & managing parties with NPI records 2
-
Shannon Cooke Baker, M.D.
Corporate family (same tax ID) 24
Affiliated clinicians 11
-
Wayne O Brown, MD
-
Bentley R McEntire, M.D.
-
Mark D. Sims, MD
-
Jared West, D.O.
-
Dallin R. Olson, MD
Medicare Care Compare: Hospice
- Listed as
- Intermountain Health Hospice - Salt Lake
- Ownership
- For-Profit
- Certified
- Apr 7, 1992
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 46D0924354 | Intermountain Health Hospice - Salt Lake | Certificate of waiver | Jan 27, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Hospice certification: CCN 461503
- Legal name
- IHC HEALTH SERVICES INC
- Doing business as
- INTERMOUNTAIN HEALTH HOSPICE - SALT LAKE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Apr 7, 1992
- Last certification
- Jan 7, 2021
- Ownership / control type
- Non-Profit - Other
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 1, 1982 in UT
- Enrollment address
- 11520 S Redwood Rd
South Jordan, UT 84095-7805
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Shannon Cooke Baker |
Corporate Director |
Jun 1, 2024 | |
| Robert Pettitt |
Corporate Director |
Jun 7, 2023 | |
| Elizabeth Owens |
Corporate Director |
Jun 1, 2024 | |
| William Caine |
Corporate Director |
Jun 7, 2023 | |
| Patricia Ricks |
Corporate Director |
Jun 1, 2024 | |
| Susan Robel |
Corporate Director |
Apr 1, 2022 | |
| Daniel G Gomez |
Corporate Director |
May 9, 2013 | |
| Deirdra Walsh |
Corporate Director |
Jun 7, 2023 | |
| Robert Spendlove |
Corporate Director |
Jun 1, 2024 | |
| Matt C Packard |
Corporate Director |
Jul 27, 2016 | |
| Riley Watts |
Corporate Officer |
Sep 16, 2024 | |
| W-2 Managing Employee |
Sep 16, 2024 | ||
| Mark Provan |
Corporate Officer |
Nov 13, 2023 | |
| Patricia K Ravert |
Corporate Director |
Oct 8, 2017 | 100% |
| William Hulterstrom |
Corporate Director |
Jun 7, 2023 | |
| Robert W Allen |
Corporate Director |
Dec 1, 2022 |
All facility ownership & control disclosures 44
| Facility | Type | Role | Since |
|---|---|---|---|
| Intermountain Health Cedar City Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1981 |
| Mountain View Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (15%) | Mar 31, 2023 |
| Intermountain Health St George Regional Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 1975 |
| Intermountain Health McKay-Dee Hospital |
Hospital | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
Jan 1, 1976 Jan 1, 1976 |
| Intermountain Health Sevier Valley Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1976 |
| Intermountain Health Bear River Valley Hospital |
Hospital | 5% Or Greater Direct Ownership Interest | Jul 5, 1995 |
| Intermountain Health Logan Regional Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1970 |
| Intermountain Health Intermountain Medical Center |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 1975 |
| Intermountain Health Alta View Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 7, 1982 |
| Intermountain Health American Fork Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1970 |
| Intermountain Health LDS Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1970 |
| Intermountain Health Orem Community Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 1975 |
| Intermountain Health Primary Children'S Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 1980 |
| Intermountain Health Utah Valley Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 1975 |
| Intermountain Health Sanpete Valley Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 1975 |
| Intermountain Health Cassia Regional Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 1975 |
| Intermountain Health Delta Community Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 1975 |
| Intermountain Health Fillmore Community Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1970 |
| Intermountain Health Heber Valley Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 1975 |
| Delta Community Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Dec 29, 2008 |
| Intermountain Health Fillmore Community Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Sep 9, 2008 |
| Heber Valley Hospital |
Hospital | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
Apr 1, 1975 Apr 1, 1975 |
| Intermountain Medical Center-Rehabilitation |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Aug 7, 2007 |
| Ihc Health Services Inc |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Apr 1, 1975 Jan 1, 1976 |
| McKay Dee Hospital |
Hospital | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
Jan 1, 1976 Jan 1, 1976 |
| Intermountain Health St George Regional Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 1975 |
| Sanpete Valley Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Apr 1, 1975 Apr 1, 1975 |
| Intermountain Health Park City Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1970 |
| Intermountain Health Riverton Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Nov 2, 2009 |
| Intermountain Health Garfield Memorial Hospital |
Hospital | Operational/Managerial Control | Jan 1, 2017 |
| Intermountain Health Garfield Memorial Hospital |
Hospital | Operational/Managerial Control | Jul 1, 2000 |
| Intermountain Health Layton Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1970 |
| Idaho Falls Community Hospital LLC |
Hospital | 5% Or Greater Direct Ownership Interest (20%) | Mar 31, 2023 |
| Intermountain Health Spanish Fork Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1970 |
| Cassia Regional Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 1975 |
| Logan Regional Hospital Transitional Care Unit |
Skilled nursing facility | Operational/Managerial Control | Jul 29, 2008 |
| Intermountain Health Home Health - Mt. Pleasant |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Aug 1, 1980 |
| Intermountain Health Home Health - Ogden |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1976 |
| Intermountain Health Home Health - St. George |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Mar 25, 2009 |
| Intermountain Health Hospice - Logan |
Hospice | 5% Or Greater Direct Ownership Interest (100%) | Oct 1, 2009 |
| Garfield Memorial Hospital |
Rural health clinic | Operational/Managerial Control | Jan 21, 2010 |
| Garfield County |
Rural health clinic | Operational/Managerial Control | Apr 26, 2010 |
| Bryce Valley Clinic |
Rural health clinic | Operational/Managerial Control | Apr 26, 2010 |
| Upper Valley Familymedicine |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Apr 7, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101005000354 | UT | Part a Provider - Hospice | 1850209420 | Practice locations: Fillmore, UT; Heber City, UT; Mount Pleasant, UT; Ogden, UT; Provo, UT; Richfield, UT; South Jordan, UT |
National Provider Directory
- Tax ID family
- Bradley S Thompson DO
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
11520 S Redwood Road
South Jordan, UT 84095
Mailing address
11520 S Redwood Road
South Jordan, UT 84095
Phone (385) 887-6000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720153711 | Medicaid | UT |
Other names
- Intermountain Health Hospice Fillmore
- Intermountain Health Hospice Heber City
- Intermountain Health Hospice Mt. Pleasant
- Intermountain Health Hospice Ogden
- Intermountain Health Hospice Provo
- Intermountain Health Hospice Richfield
- Intermountain Health Hospice Salt Lake
Other providers in South Jordan, UT
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All providers in South Jordan, UT · Community Based Hospice Care Agency in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2025. 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.