Provider Demographics
NPI:1992058515
Name:GOLDEN LIVING TAYLORSVILLE MANAGEMENT LLC
Entity type:Organization
Organization Name:GOLDEN LIVING TAYLORSVILLE MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-478-4117
Mailing Address - Street 1:1800 SW 1ST AVE
Mailing Address - Street 2:# 180
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5362
Mailing Address - Country:US
Mailing Address - Phone:503-684-1123
Mailing Address - Fax:503-684-2533
Practice Address - Street 1:2011 W 4700 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84129-1107
Practice Address - Country:US
Practice Address - Phone:801-966-4286
Practice Address - Fax:801-966-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility