MEDICARE: KEARNS SENIOR LIVING, LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275007858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEARNS SENIOR LIVING, LLC

Provider Business Mailing Address
First Line	:	2020 W RUDASILL RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-7800
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5524 W 6200 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84118-7927
Country	:	US
Telephone Number	:	801-840-4600
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED SIGNATORY
Name	:	DAVID FRESHWATER
Credential	:
Telephone Number	:	520-797-4000

Provider Enumeration Date	:	01/16/2019
Last Update Date	:	01/19/2023

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