46D1049360 CLIA NUMBER - INTERMOUNTAIN HEALTH HOME HEALTH - SALT LAKE

Laboratory Demographics

  • CLIA Code: 46D1049360
  • Facility Name: INTERMOUNTAIN HEALTH HOME HEALTH - SALT LAKE
  • Facility Address: 11520 S REDWOOD ROAD
    SOUTH JORDAN, UT
    ZIP 84095
  • Facility Phone: 385 887-6000
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: DOMINIC MOORE
  • NPI Number: 1851715049
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 46D1049360
LAB Type Home Health Agency
Facility Name INTERMOUNTAIN HEALTH HOME HEALTH - SALT LAKE
Street 11520 S REDWOOD ROAD
City SOUTH JORDAN
State UT
ZIP 84095
Phone 385 887-6000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/4/2024
Certificate Expiration Date 1/3/2026
Facility Type Home Health Agency
Lab Director DOMINIC MOORE

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This page was last updated on: 9/29/2025