MEDICARE: DAYWEST REHABILITATION 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	261QR0400X	Rehabilitation Clinic/Center	43084	UT

General Provider Information

NPI Number	:	1811990153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAYWEST REHABILITATION LLC

Provider Business Mailing Address
First Line	:	4578 HIGHLAND DR
Second Line	:	STE 190
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4204
Country	:	US
Telephone Number	:	801-272-5008
Fax Number	:	801-272-5009

Provider Business Practice Location Address
First Line	:	4578 HIGHLAND DR
Second Line	:	STE 190
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4204
Country	:	US
Telephone Number	:	801-272-5008
Fax Number	:	801-272-5009

Authorized Official
Title or Position	:	CFO
Name	:	TRACI RANDALL
Credential	:
Telephone Number	:	801-621-6950

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	11/08/2007

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