MEDICARE: JORDAN SALUMU MASUDI

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	251E00000X	Home Health Agency
2	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1194523712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN SALUMU MASUDI

Provider Business Mailing Address
First Line	:	875 W RED CLIFFS DR STE 9
Second Line	:
City	:	WASHINGTON
State	:	UT
Zip	:	84780-1586
Country	:	US
Telephone Number	:	435-559-4006
Fax Number	:

Provider Business Practice Location Address
First Line	:	875 W RED CLIFFS DR STE 9
Second Line	:
City	:	WASHINGTON
State	:	UT
Zip	:	84780-1586
Country	:	US
Telephone Number	:	434-559-4006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2025
Last Update Date	:	03/23/2026

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Directions to “ JORDAN SALUMU MASUDI ” Practice Location

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