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Contact Information

LEGACY VILLAGE HEALTHCARE LLC
5472 S 3200 W
TAYLORSVILLE, UT84129-7804
 Phone: 801-269-0700
 Fax: 801-269-1512
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
 

Alzheimer Center /Dementia Center/Dementia Special Care Unit

311500000X
Indicates primary specialty

NPI Profile & details for LEGACY VILLAGE HEALTHCARE LLC

NPI # 1881866499
LBN Legal business name LEGACY VILLAGE HEALTHCARE LLC
Authorized official PAUL FAIRHOLM - (MANAGING MEMBER)
Entity Organization
Organization subpart 1 Yes
Enumeration date 03/24/2008
Last updated 04/22/2015 - About 11 years ago
Identifiers
UT License # TO BE DETERMINED
UT License # TO BE DETERMINED
UT Medicaid 113661303001
UT Medicaid 800008673001
UT Medicaid 870520717001
UT Medicaid 870638970001
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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