| Organization Name: | OVERLAKE TERRACE ASSISTED LIVING |
| NPI Number: | 1912241001 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AARON C BENTON (SENIOR VICE PRESIDENT) |
| Mailing Address: | 2825 E Cottonwood Pkwy Suite 500 Salt Lake City |
| State: | UT US |
| Postal Code: | 841217055 |
| Phone Number: | 8017904652 |
| Fax Number: | 8012141970 |
| NPI Enumeration Date: | 11/15/2012 |
| NPI Last Update Date: | 11/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 310400000X |
| License Number: | 603224991 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Assisted Living Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |