NPIMap

Organization Active NPI

Legacy Healthcare of Layton LLC

  • Skilled Nursing Facility
  • Layton, UT
National Provider Identifier
1134442825
Registry record updated Jul 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LEGACY HEALTHCARE OF LAYTON LLC
Practice address
1203 N Fairfield Rd
Layton, UT 84041-8321
Phone
(801) 927-5927
Fax
(801) 927-6235
NPI assigned
Mar 9, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Paul Fairholm
Title
Owner
Phone
(801) 269-0700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1203 N Fairfield Rd
Layton, UT 84041-8321

Mailing address

1203 N Fairfield Rd
Layton, UT 84041-8321
Phone (801) 927-5927

Other identifiers 1

IdentifierTypeStateIssuer
264368361001MedicaidUT

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341964800000",
    "number": "1134442825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 N FAIRFIELD RD",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840418321",
            "telephone_number": "801-927-5927",
            "fax_number": "801-927-6235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 N FAIRFIELD RD",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840418321",
            "telephone_number": "801-927-5927",
            "fax_number": "801-927-6235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTHCARE OF LAYTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-09",
        "last_updated": "2012-07-11",
        "status": "A",
        "authorized_official_last_name": "FAIRHOLM",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-269-0700"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "264368361001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Layton, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.