Healthcare Provider Details

I. General information

NPI: 1700182961
Provider Name (Legal Business Name): LEGACY HEALTHCARE OF LAYTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 02/07/2011
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: 801-807-0113
  • Fax: 801-927-6235
Mailing address:
  • Phone: 801-807-0113
  • Fax: 801-927-6235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2010-NCF-98320
License Number StateUT

VIII. Authorized Official

Name: JAUNICE MINOR
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 801-807-0113