Provider Demographics
NPI:1558993337
Name:HOLLADAY HOME ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:HOLLADAY HOME ASSISTED LIVING LLC
Other - Org Name:HOLLADAY HOME FOR THE ELDERLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-860-6906
Mailing Address - Street 1:3436 W 11520 S
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8157
Mailing Address - Country:US
Mailing Address - Phone:801-860-6906
Mailing Address - Fax:
Practice Address - Street 1:5950 S HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84121-1328
Practice Address - Country:US
Practice Address - Phone:801-277-8371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility