Provider Demographics
NPI:1811990153
Name:DAYWEST REHABILITATION LLC
Entity type:Organization
Organization Name:DAYWEST REHABILITATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-621-6950
Mailing Address - Street 1:4578 HIGHLAND DR
Mailing Address - Street 2:STE 190
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4204
Mailing Address - Country:US
Mailing Address - Phone:801-272-5008
Mailing Address - Fax:801-272-5009
Practice Address - Street 1:4578 HIGHLAND DR
Practice Address - Street 2:STE 190
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4204
Practice Address - Country:US
Practice Address - Phone:801-272-5008
Practice Address - Fax:801-272-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT43084261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT466514Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER