Auburn Crest Home Health Utah, LLC
Organization Active NPI Home Health Agency · Draper, UT
NPI 1831666817 · NPPES record last updated Aug 9, 2024
Key facts
- NPI
- 1831666817
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- AUBURN CREST HOME HEALTH UTAH, LLC
- Practice address
- 12176 S 1000 E Ste 2
Draper, UT 84020-3221 - Phone
- (801) 327-2295
- NPI assigned
- Oct 29, 2018
- Organization subpart
- No
Authorized official
- Name
- Jason Fletcher
- Title
- President
- Phone
- (208) 376-7298
Facilities with the same owner 4
Affiliated clinicians 2
-
Amy Flynn, APRN
-
Jamie Ann Romney, FNP-BC
Medicare Care Compare: Home health agency
- Listed as
- Auburn Crest Home Health Utah, LLC
- Overall star rating
- ★★★★☆ 3.5 of 5
- Ownership
- Proprietary
- Certified
- Apr 12, 2019
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Home health agency certification: CCN 467356
- Legal name
- AUBURN CREST HOME HEALTH UTAH LLC
- Doing business as
- AUBURN CREST HOME HEALTH AND HOSPICE
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Apr 12, 2019
- Last certification
- Apr 12, 2019
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Proprietary
- Incorporated
- Oct 10, 2018 in ID
- Enrollment address
- 12244 S Business Park Dr
Ste 215
Draper, UT 84020-6561
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Keith C Fletcher |
5% Or Greater Indirect Ownership Interest | Oct 10, 2018 | 16.32% |
| Elizabeth Fletcher |
5% Or Greater Indirect Ownership Interest | Oct 10, 2018 | 22% |
| CBKM Investments |
5% Or Greater Indirect Ownership Interest | Oct 10, 2018 | 5% |
| Jason R Fletcher |
5% Or Greater Indirect Ownership Interest | Oct 10, 2018 | 32.15% |
| Corporate Officer |
Oct 10, 2018 | ||
| Operational/Managerial Control |
Oct 10, 2018 | ||
| Florence E Fletcher |
5% Or Greater Indirect Ownership Interest | Oct 10, 2018 | 15.3% |
| Kameron Ann Lemon |
5% Or Greater Indirect Ownership Interest | Oct 10, 2018 | 14.24% |
| Fletcher Investments, LP |
5% Or Greater Indirect Ownership Interest | Oct 10, 2018 | 51% |
| Elson Capital Group, LLC |
5% Or Greater Indirect Ownership Interest | Oct 10, 2018 | 44% |
| Synergy Healthcare Holdings LLC |
5% Or Greater Direct Ownership Interest | Oct 10, 2018 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190102002120 | UT | Part a Provider - Home Health Agency | 4789929217 | Practice locations: Draper, UT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
12176 S 1000 E Ste 2
Draper, UT 84020-3221
Mailing address
PO Box 1176
Meridian, ID 83680-1176
Phone (208) 376-7298
Other providers in Draper, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 9, 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.