Provider Demographics
NPI:1730546797
Name:SEASONS ASSISTED LIVING OF FARR WEST, LLC
Entity type:Organization
Organization Name:SEASONS ASSISTED LIVING OF FARR WEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-866-5009
Mailing Address - Street 1:1979 N HERITAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FARR WEST
Mailing Address - State:UT
Mailing Address - Zip Code:84404-9767
Mailing Address - Country:US
Mailing Address - Phone:801-866-5009
Mailing Address - Fax:
Practice Address - Street 1:1979 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:FARR WEST
Practice Address - State:UT
Practice Address - Zip Code:84404-9767
Practice Address - Country:US
Practice Address - Phone:801-866-5009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2015-ALII-UT000720310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility