Provider Demographics
NPI:1477958353
Name:CHP LAYTON UT TENANT CORP.
Entity Type:Organization
Organization Name:CHP LAYTON UT TENANT CORP.
Other - Org Name:FAIRFIELD VILLAGE OF LAYTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MADDRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-540-7519
Mailing Address - Street 1:450 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3383
Mailing Address - Country:US
Mailing Address - Phone:801-807-0111
Mailing Address - Fax:
Practice Address - Street 1:1201 N FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-8321
Practice Address - Country:US
Practice Address - Phone:407-540-7652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT310400000X, 311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)