Provider Demographics
NPI:1972643559
Name:SOUTH DAVIS COMMUNITY HOSPITAL, INC.
Entity Type:Organization
Organization Name:SOUTH DAVIS COMMUNITY HOSPITAL, INC.
Other - Org Name:THE INN ON BARTON CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-295-2361
Mailing Address - Street 1:401 S 400 E
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4933
Mailing Address - Country:US
Mailing Address - Phone:801-295-2361
Mailing Address - Fax:801-295-1398
Practice Address - Street 1:499 E 500 S
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-3801
Practice Address - Country:US
Practice Address - Phone:801-298-4200
Practice Address - Fax:801-397-8029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2006-ALII-4791310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility