Healthcare Provider Details

I. General information

NPI: 1134442825
Provider Name (Legal Business Name): LEGACY HEALTHCARE OF LAYTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 N FAIRFIELD RD
LAYTON UT
84041-8321
US

IV. Provider business mailing address

1203 N FAIRFIELD RD
LAYTON UT
84041-8321
US

V. Phone/Fax

Practice location:
  • Phone: 801-927-5927
  • Fax: 801-927-6235
Mailing address:
  • Phone: 801-927-5927
  • Fax: 801-927-6235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: PAUL FAIRHOLM
Title or Position: OWNER
Credential:
Phone: 801-269-0700