MEDICARE: SEASONS ASSISTED LIVING OF FARR WEST, LLC

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	2015-ALII-UT000720	UT

General Provider Information

NPI Number	:	1730546797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEASONS ASSISTED LIVING OF FARR WEST, LLC

Provider Business Mailing Address
First Line	:	1979 N HERITAGE DRIVE
Second Line	:
City	:	FARR WEST
State	:	UT
Zip	:	84404-9767
Country	:	US
Telephone Number	:	801-866-5009
Fax Number	:

Provider Business Practice Location Address
First Line	:	1979 HERITAGE DR
Second Line	:
City	:	FARR WEST
State	:	UT
Zip	:	84404-9767
Country	:	US
Telephone Number	:	801-866-5009
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ERIC MARTZ
Credential	:
Telephone Number	:	801-866-5009

Provider Enumeration Date	:	01/21/2016
Last Update Date	:	01/21/2016

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