Provider Demographics
NPI:1689677932
Name:DAYWEST HEALTHCARE SERVICES INC.
Entity Type:Organization
Organization Name:DAYWEST HEALTHCARE SERVICES INC.
Other - Org Name:DAYWEST HEALTHCARE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:CAROLYN
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-268-6801
Mailing Address - Street 1:1492 E RIDGELINE DR
Mailing Address - Street 2:#1
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405
Mailing Address - Country:US
Mailing Address - Phone:801-621-6950
Mailing Address - Fax:
Practice Address - Street 1:3665 BRINKER AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2017
Practice Address - Country:US
Practice Address - Phone:801-627-2273
Practice Address - Fax:801-334-8240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2004-NCF-44314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT203460210005Medicaid
UT203460210005Medicaid