Provider Demographics
NPI:1679754808
Name:GOLDEN LIVING OREM
Entity type:Organization
Organization Name:GOLDEN LIVING OREM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:801-977-1141
Mailing Address - Street 1:960 S GENEVA RD
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5847
Mailing Address - Country:US
Mailing Address - Phone:801-225-6559
Mailing Address - Fax:801-225-0372
Practice Address - Street 1:960 S GENEVA RD
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5847
Practice Address - Country:US
Practice Address - Phone:801-225-6559
Practice Address - Fax:801-225-0372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2007-ALI-323310400000X
UT2006-ALII-944310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility