=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710859210
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRILITHON HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2025
-----------------------------------------------------
Last Update Date | 09/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1371 W SOUTH JORDAN PKWY
-----------------------------------------------------
City | SOUTH JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84095-8848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-253-1370
-----------------------------------------------------
Fax | 801-797-0517
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1371 W SOUTH JORDAN PKWY
-----------------------------------------------------
City | SOUTH JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84095-8848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-253-1370
-----------------------------------------------------
Fax | 801-797-0517
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | SOON BURNAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 949-540-1249
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------