MEDICARE: THE SARAH DAFT HOME

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	310400000X	Assisted Living Facility	2007-AL1-264	UT

General Provider Information

NPI Number	:	1720291131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SARAH DAFT HOME

Provider Business Mailing Address
First Line	:	737 S 1300 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-3713
Country	:	US
Telephone Number	:	801-582-5104
Fax Number	:	801-582-8808

Provider Business Practice Location Address
First Line	:	737 S 1300 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-3713
Country	:	US
Telephone Number	:	801-582-5104
Fax Number	:	801-582-8808

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MARSHA J GIBSON
Credential	:
Telephone Number	:	801-582-5104

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

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