Healthcare Provider Details

I. General information

NPI: 1194523712
Provider Name (Legal Business Name): JORDAN SALUMU MASUDI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 W RED CLIFFS DR STE 9
WASHINGTON UT
84780-1586
US

IV. Provider business mailing address

875 W RED CLIFFS DR STE 9
WASHINGTON UT
84780-1586
US

V. Phone/Fax

Practice location:
  • Phone: 434-559-4006
  • Fax:
Mailing address:
  • Phone: 435-559-4006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: