Provider Demographics
NPI:1700182961
Name:LEGACY HEALTHCARE OF LAYTON, LLC
Entity Type:Organization
Organization Name:LEGACY HEALTHCARE OF LAYTON, LLC
Other - Org Name:LEGACY VILLAGE OF LAYTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-807-0113
Mailing Address - Street 1:1203 N FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-8321
Mailing Address - Country:US
Mailing Address - Phone:801-807-0113
Mailing Address - Fax:801-927-6235
Practice Address - Street 1:1203 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:801-807-0113
Practice Address - Fax:801-927-6235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2010-NCF-98320314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT465174Medicare Oscar/Certification