MEDICARE: WESTSIDE COMMUNITY NURSING 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	313M00000X	Nursing Facility/Intermediate Care Facility		UT

General Provider Information

NPI Number	:	1457354755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE COMMUNITY NURSING CENTER

Provider Business Mailing Address
First Line	:	876 W 700 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-1404
Country	:	US
Telephone Number	:	801-355-9649
Fax Number	:	801-531-7003

Provider Business Practice Location Address
First Line	:	876 W 700 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-1404
Country	:	US
Telephone Number	:	801-355-9649
Fax Number	:	801-531-7003

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SUSAN CHAVIS
Credential	:
Telephone Number	:	801-355-9649

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/22/2020

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Directions to “WESTSIDE COMMUNITY NURSING CENTER ” Practice Location

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