Provider Demographics
NPI:1134282833
Name:COUNTRY GARDEN HOMES, INC.
Entity Type:Organization
Organization Name:COUNTRY GARDEN HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-807-9124
Mailing Address - Street 1:1635 NORTH ANGLE STREET
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1908
Mailing Address - Country:US
Mailing Address - Phone:801-525-1214
Mailing Address - Fax:801-525-1214
Practice Address - Street 1:1635 NORTH ANGLE ST
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1908
Practice Address - Country:US
Practice Address - Phone:801-525-1214
Practice Address - Fax:801-525-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTALI46720310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility