Provider Demographics
NPI:1154752178
Name:QUAIL MEADOW ASSISTED LIVING, LLC
Entity type:Organization
Organization Name:QUAIL MEADOW ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-866-5009
Mailing Address - Street 1:786 E 2100 N
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-2935
Mailing Address - Country:US
Mailing Address - Phone:801-782-7440
Mailing Address - Fax:
Practice Address - Street 1:786 E 2100 N
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-2935
Practice Address - Country:US
Practice Address - Phone:801-782-7440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-01
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2013-ALII-UT000615310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility