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NPI Code Detail

MEDICARE: SUCCESSOR HEALTHCARE LLC

MEDICARE: SUCCESSOR HEALTHCARE 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
1273R00000XPsychiatric Hospital UnitUT

General Provider Information

NPI Number : 1144526997
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUCCESSOR HEALTHCARE LLC
Provider Business Mailing Address
First Line : 451 EAST BISHOP FEDERAL LANE
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-2357
Country : US
Telephone Number : 801-468-6856
Fax Number : 801-468-6850
Provider Business Practice Location Address
First Line : 451 EAST BISHOP FEDERAL LANE
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-2357
Country : US
Telephone Number : 801-468-6856
Fax Number : 801-468-6850
Authorized Official
Title or Position : TREASURER
Name : MS. SOON BURNAM
Credential :
Telephone Number : 949-540-1249
Provider Enumeration Date : 01/26/2011
Last Update Date : 12/03/2018

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Directions to “SUCCESSOR HEALTHCARE LLC ” Practice Location

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