Senior Services Provider Contract Information


APPLICATION INSTRUCTIONS

Please return with your completed and signed contract the following:

  • Contract form with required signatures
  • Current W-9
  • Certificate of Insurance indicating required coverage amount
  • Current business license 
          and/or
  • Current DOPL Home Health/Personal Care License
  • Completed cover sheet

Contracts missing any of the above items will be returned to sender as unprocessed. 

Mail:             

Davis County Health Department

Attention:  Shawna Mahan
PO Box 618
Farmington, UT  84025

Fax: 801-525-5071

Email: ShawnaN@co.davis.ut.us

Hand Delivery:  (not a mailing address)

Davis County Health Department
Attention: Shawna Mahan
22 South State Street - 3rd Floor
Clearfield, UT       
Phone:  801-525-5050

Administrative Staff

Kristy Cottrell -  Deputy Director

In-Home Services Bureau
Shawna Mahan - Manager

Senior Activity Centers Bureau
Debbie Draper - Manager

Outreach & Advocacy Bureau 
John Cowan - Manager

Contact Information

Physical Address
22 South State Street
3rd Floor
Clearfield, Utah 84015

Mailing Address
Davis County Health Department
Senior Services
P.O. Box 618
Farmington, Utah 84025

Phone Numbers
(801) 525-5050 :: Main
(801) 525-5071 :: Fax

Hours
Monday – Friday
8:00 a.m. to 5:00 p.m. (except legal holidays)

Healthy Choices | Healthy People | Healthy Communities

Copyright © 2015 Davis County Government
question