MEDICARE: NIITSUMA LIVING CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	AL17234	UT

General Provider Information

NPI Number	:	1144364662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIITSUMA LIVING CENTER

Provider Business Mailing Address
First Line	:	4347 S 700 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3063
Country	:	US
Telephone Number	:	801-269-1230
Fax Number	:	801-269-1230

Provider Business Practice Location Address
First Line	:	4347 S 700 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3063
Country	:	US
Telephone Number	:	801-269-1230
Fax Number	:	801-269-1230

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. REBECCA NIITSUMA
Credential	:	OWNER
Telephone Number	:	801-269-1230

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	08/22/2020

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