SUCCESSOR HEALTHCARE LLC (NPI# 1255634879) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255634879 |
| Entity Type | Organization |
| Organization Name | SUCCESSOR HEALTHCARE LLC |
| Other Organization Name | ST. JOSEPH VILLA |
| Practice Address |
451 Bishop Federal Ln Salt Lake City UT 84115-2357 |
| Practice Telephone | 8014877557 |
| Practice Fax Number | 8014871112 |
| Mailing Telephone | 8014877557 |
| Mailing Fax Number | 8014871112 |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2016-06-03 |
| Authorized Official Name | MS. SOON BURNAM (TREASURER OF MANAGEMENT COMPANY) |
| Authorized Official Telephone | 9495401249 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 310400000X | Assisted Living Facility | UT | Nursing & Custodial Care Facilities | |
| Y | 314000000X | Skilled Nursing Facility | UT | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| St. Joseph Villa | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144526997 | Successor Healthcare LLC | Psychiatric Unit | 451 East Bishop Federal Lane, Salt Lake City, UT 84115-2357 | 2011-01-26 |
| 1619599503 | Successor Healthcare LLC | Assisted Living Facility | 451 E Bishop Federal Ln, Salt Lake City, UT 84115-2357 | 2020-05-13 |
| Street Address |
451 BISHOP FEDERAL LN |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84115-2357 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376545798 | Mary Jane Norman | Internal Medicine | 451 Bishop Federal Ln, Salt Lake City, UT 84115-2357 | 2005-08-15 |
| 1346544962 | Connie J Simms | Social Worker | 451 Bishop Federal Ln, Salt Lake City, UT 84115-2357 | 2010-12-23 |
| 1558693523 | Mary Jane Norman Md A Professional Corporation | Medical Genetics | 451 Bishop Federal Ln, Salt Lake City, UT 84115-2357 | 2010-02-02 |
| 1003010158 | Christus St. Joseph Villa | Religious Nonmedical Health Care Institution | 451 Bishop Federal Ln, Salt Lake City, UT 84115-2357 | 2007-06-13 |
| 1780887521 | Simone Jasmin Hennig | Social Worker | 451 Bishop Federal Ln, Salt Lake City, UT 84115-2357 | 2007-06-08 |
| 1124142427 | Ihc Health Services Inc | Clinic/Center | 451 Bishop Federal Ln, Salt Lake City, UT 84115-2357 | 2007-03-19 |
| 1184708919 | Christus Health Utah | Psychiatric Hospital | 451 Bishop Federal Ln, Salt Lake City, UT 84115-2357 | 2006-10-25 |
| 1699868950 | Sonja J Bates | Nurse Practitioner | 451 Bishop Federal Ln, Salt Lake City, UT 84115-2357 | 2006-10-01 |
| 1093774218 | Christus Health Utah | Skilled Nursing Facility | 451 Bishop Federal Ln, Salt Lake City, UT 84115-2357 | 2006-03-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396344198 | Shannon Ballinger | Clinic/Center | 1470 400 W, Salt Lake City, UT 84115 | 2020-10-22 |
| 1992346704 | Anicka Inc | Clinic/Center | 3195 South Main St, Ste 260, South Salt Lake, UT 84115 | 2019-10-02 |
| 1083177505 | Vitor Gabriel Giuliani Alcantara Carioca | Specialist/Technologist | 1850 South Campus Drive, Salt Lake City, UT 84115 | 2019-04-11 |
| 1427528371 | Samuel James Leonhart | Behavior Technician | 354 East Coatsville Drive, Salt Lake City, UT 84115 | 2018-12-04 |
| 1093228645 | Eco Pharmacy LLC | Pharmacy | 3702 S State Street Suite 115, South Salt Lake City, UT 84115 | 2017-11-06 |
| 1568973055 | Eco Apothecary LLC | Pharmacy | 3701 S State Street Suite 114, South Salt Lake City, UT 84115 | 2017-10-24 |
| 1548780455 | Kelly Lund | Case Manager/Care Coordinator | 447 W. Bearcat Dr., Salt Lake City, UT 84115 | 2017-06-21 |
| 1104271238 | The Church of Philadelphia Inc. | Community/Behavioral Health | 2358 South Main Street, Salt Lake City, UT 84115 | 2016-04-26 |
| 1710368626 | Jennifer Swanhild Edwards | Counselor | 140 W 2100 S Ste 244, Salt Lake City, UT 84115 | 2015-06-16 |
| 1508247065 | John Mcguire | Health Educator | 1370 S. West Temple, Salt Lake City, UT 84115 | 2015-06-10 |
| Find all providers in zip 84115 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962955237 | Beaver Valley Hospital | Skilled Nursing Facility | 4782 S Holladay Blvd, Salt Lake City, UT 84117-5444 | 2016-08-03 |
| 1902130222 | Beaver Valley Hospital | Skilled Nursing Facility | 2200 East 3300 South, Salt Lake City, UT 84109 | 2009-09-21 |
| 1598990699 | Beaver Valley Hospital | Skilled Nursing Facility | 4600 S. Highland Drive, Salt Lake City, UT 84117 | 2009-05-19 |
| 1629129689 | Subtenant 1430 East 4500 South LLC | Skilled Nursing Facility | 1430 East 4500 South, Salt Lake City, UT 84117-4208 | 2007-01-16 |
| 1760594048 | Utah State Veterans Nursing Home | Skilled Nursing Facility | 700 Foothill Blvd, Salt Lake City, UT 84113-1104 | 2006-08-31 |
| 1225061229 | Salt Lake Operations, LLC | Skilled Nursing Facility | 1201 E 4500 S, Salt Lake City, UT 84117-4124 | 2006-07-10 |
| 1679526156 | Sunrise Senior Living Services, Inc | Skilled Nursing Facility | 76 S 500 E, Salt Lake City, UT 84102-1044 | 2006-05-18 |
| 1326098039 | Eagles Soar Inc. | Skilled Nursing Facility | 433 E 2700 S, Salt Lake City, UT 84115-3325 | 2006-05-11 |
| 1548218050 | Evergreen At Holladay, L.L.C. | Skilled Nursing Facility | 4600 South Highland Dr, Salt Lake City, UT 84117-5108 | 2006-05-05 |
| 1457338956 | Mission Health Services | Skilled Nursing Facility | 1216 E 1300 S, Salt Lake City, UT 84105-1949 | 2005-12-27 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84115 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.