Provider Demographics
NPI:1831686823
Name:COVINGTON SENIOR LIVING LLC
Entity type:Organization
Organization Name:COVINGTON SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TYLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-494-2020
Mailing Address - Street 1:1925 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2057
Mailing Address - Country:US
Mailing Address - Phone:801-494-2020
Mailing Address - Fax:801-509-9445
Practice Address - Street 1:1925 N STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2057
Practice Address - Country:US
Practice Address - Phone:801-494-2020
Practice Address - Fax:801-509-9445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2018-AL11-UT-000819310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility