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)		UT

General Provider Information

NPI Number	:	1942664156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAYTON PARK MEMORY CARE

Provider Business Mailing Address
First Line	:	101 N FORT LN
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-5682
Country	:	US
Telephone Number	:	801-549-8942
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 N FORT LN
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-5682
Country	:	US
Telephone Number	:	801-549-8942
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JENAE B OSMAN
Credential	:
Telephone Number	:	801-549-8942

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	04/13/2016

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Directions to “LAYTON PARK MEMORY CARE ” Practice Location

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