Provider Demographics
NPI:1043375108
Name:WENTWORTH SENIOR COMMUNITY AT DRAPER
Entity type:Organization
Organization Name:WENTWORTH SENIOR COMMUNITY AT DRAPER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-523-9393
Mailing Address - Street 1:11631 S 700 E
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8288
Mailing Address - Country:US
Mailing Address - Phone:801-523-9393
Mailing Address - Fax:801-572-2033
Practice Address - Street 1:11631 S 700 E
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8288
Practice Address - Country:US
Practice Address - Phone:801-523-9393
Practice Address - Fax:801-572-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005-ALII-9817310400000X, 3104A0625X, 3104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Not Answered3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances