MEDICARE: ZION INTERMEDIATE CARE INC

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	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1881474484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZION INTERMEDIATE CARE INC

Provider Business Mailing Address
First Line	:	119 S PACIFIC DR STE 109
Second Line	:
City	:	AMERICAN FORK
State	:	UT
Zip	:	84003-2399
Country	:	US
Telephone Number	:	801-763-9299
Fax Number	:

Provider Business Practice Location Address
First Line	:	4028 S 4800 W
Second Line	:
City	:	WEST VALLEY
State	:	UT
Zip	:	84120-4537
Country	:	US
Telephone Number	:	801-968-8122
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISTI BUCK
Credential	:	ADMINISTRATOR
Telephone Number	:	801-473-7042

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	10/02/2023

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