MEDICARE: LAYTON PARK MEMORY CARE

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	311500000X	Alzheimer Center (Dementia Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639634561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAYTON PARK MEMORY CARE

Provider Business Mailing Address
First Line	:	1133 N MAIN ST # 300
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-4800
Country	:	US
Telephone Number	:	801-546-7417
Fax Number	:	801-546-5230

Provider Business Practice Location Address
First Line	:	101 N FORT LN
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-5682
Country	:	US
Telephone Number	:	801-823-3112
Fax Number	:	801-719-6473

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JARED ANDERSEN
Credential	:
Telephone Number	:	801-546-7417

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	02/05/2019

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Directions to “LAYTON PARK MEMORY CARE ” Practice Location

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