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General NPI Number Information
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NPI Number | 1154752178
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Entity Type | Organization
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Legal Business Name | QUAIL MEADOW ASSISTED LIVING, LLC
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Dates
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Enumeration Date | 12/01/2013
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 786 E 2100 N
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City | NORTH OGDEN
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State | UT
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Zip | 84414-2935
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Country | US
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Telephone | 801-782-7440
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Fax |
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Provider Business Mailing Address
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Address Line | 786 E 2100 N
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City | NORTH OGDEN
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State | UT
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Zip | 84414-2935
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Country | US
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Telephone | 801-782-7440
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | ERIC MARTZ
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Credential |
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Telephone | 801-866-5009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 2013-ALII-UT000615
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License Number State | UT
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