MEDICARE: CHATEAU BRICKYARD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320700000X	Physical Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1164635827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHATEAU BRICKYARD, INC.

Provider Business Mailing Address
First Line	:	3080 S 1300 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3000
Country	:	US
Telephone Number	:	801-466-9999
Fax Number	:	801-466-7650

Provider Business Practice Location Address
First Line	:	3080 S 1300 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3000
Country	:	US
Telephone Number	:	801-466-9999
Fax Number	:	801-466-7650

Authorized Official
Title or Position	:	SECRETARY
Name	:	MR. KEVIN G TAYLOR
Credential	:
Telephone Number	:	801-977-1141

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	08/22/2020

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