Ambrose Healthcare LLC
Organization Active NPI Home Health Agency · Layton, UT
NPI 1912401613 · NPPES record last updated Mar 19, 2018
Key facts
- NPI
- 1912401613
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 2018-HHA-UT000840
- Legal business name
- AMBROSE HEALTHCARE LLC
- Practice address
- 920 Heritage Park Blvd Ste 120
Layton, UT 84041-5609 - Phone
- (801) 335-6455
- NPI assigned
- Mar 19, 2018
- Organization subpart
- No
Authorized official
- Name
- Mr. Travis Collette
- Title
- VP of Business Development
- Phone
- (208) 360-7668
Facilities with the same owner 10
Affiliated clinicians 39
-
Thomas R Carn, M.D.
-
Holly Lee Carter, APRN, FNP
-
Sean R Curzon, DO
-
Michael Scot Dee, M.D.
-
Sean Cameron Doyle, D.O.
-
Allison Savanna Felshaw, P.A.
-
Todd William Furness, D.O.
-
Joseph Ammon Garcia, M.D.
-
Sarah Elizabeth Groneman, APRN
-
Kade T Huntsman, MD
-
Valerie Jean Juarez, APRN
-
Troy Lunceford, MD
-
Brayden McBride, M.D.
-
Garry Tim Miller II, D.O.
-
Dana H Munn, D.O.
-
Reed Parkinson, MD
-
Daniel R Patty, DPM
-
Scott David Peterson, M.D.
Medicare Care Compare: Home health agency
- Listed as
- Utah Home Health - North
- Overall star rating
- ★★★★★ 5 of 5
- Ownership
- Proprietary
- Certified
- Mar 27, 2019
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 46D2147832 | Ambrose Healthcare, LLC | Certificate of waiver | Apr 26, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Home health agency certification: CCN 467355
- Legal name
- AMBROSE HEALTHCARE LLC
- Doing business as
- UTAH HOME HEALTH - NORTH
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Mar 27, 2019
- Last certification
- Mar 27, 2019
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Proprietary
- Incorporated
- Jan 22, 2018 in ID
- Enrollment address
- 563 W 500 S
Ste 420
Bountiful, UT 84010-8246
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Jaimi Ann Willson |
5% Or Greater Indirect Ownership Interest | Dec 15, 2025 | 20% |
| Aspen Healthcare Midco Holdings LLC |
5% Or Greater Direct Ownership Interest | Dec 15, 2025 | 100% |
| Aspen Healthcare Holdings LLC |
5% Or Greater Indirect Ownership Interest | Dec 15, 2025 | 100% |
| Trevor Collette |
5% Or Greater Indirect Ownership Interest | Dec 15, 2025 | 20% |
| The Jeffrey and Jaimi Willson Family Trust |
5% Or Greater Indirect Ownership Interest | Dec 15, 2025 | 20% |
| Travis Collette |
5% Or Greater Indirect Ownership Interest | Dec 15, 2025 | 20% |
| Derek Paul Collette |
5% Or Greater Indirect Ownership Interest | Dec 15, 2025 | 20% |
| Riley Edgington |
Contracted Managing Employee |
Dec 15, 2025 | 100% |
| Jared Scott Collette |
5% Or Greater Indirect Ownership Interest | Dec 15, 2025 | 20% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180904001662 | UT | Part a Provider - Home Health Agency | 8527318005 | Practice locations: Bountiful, UT; Orem, UT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 2018-HHA-UT000840 | Yes |
Addresses
Primary practice location
920 Heritage Park Blvd Ste 120
Layton, UT 84041-5609
Mailing address
920 Heritage Park Blvd Ste 120
Layton, UT 84041-5609
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2018-HHA-UT000840 | Other | UT | STATE LICENSE NUMBER |
Other providers in Layton, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 19, 2018. 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.