Provider Demographics
NPI:1083789770
Name:OK SENIOR HOUSING HOLLADAY
Entity Type:Organization
Organization Name:OK SENIOR HOUSING HOLLADAY
Other - Org Name:DBA THE WELLINGTON SENIOR RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALLRED
Authorized Official - Suffix:
Authorized Official - Credentials:BS, HFA, CAM, CMCA
Authorized Official - Phone:801-281-3477
Mailing Address - Street 1:4522 S 1300 E
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4177
Mailing Address - Country:US
Mailing Address - Phone:801-281-3477
Mailing Address - Fax:801-268-1854
Practice Address - Street 1:4522 S 1300 E
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84117-4177
Practice Address - Country:US
Practice Address - Phone:801-281-3477
Practice Address - Fax:801-268-1854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility