NPIMap

Organization Active NPI

Successor Healthcare LLC

Doing business as Marian Center

  • Psychiatric Hospital Unit
  • Salt Lake City, UT
National Provider Identifier
1144526997
Registry record updated Dec 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
SUCCESSOR HEALTHCARE LLC
Doing business as
Marian Center
Practice address
451 East Bishop Federal Lane
Salt Lake City, UT 84115-2357
Phone
(801) 468-6856
Fax
(801) 468-6850
NPI assigned
Jan 26, 2011
Last updated
Dec 3, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Soon Burnam
Title
Treasurer
Phone
(949) 540-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X UT Primary

Addresses

Primary practice location

451 East Bishop Federal Lane
Salt Lake City, UT 84115-2357

Mailing address

451 East Bishop Federal Lane
Salt Lake City, UT 84115-2357
Phone (801) 468-6856

Other names 1

  • Marian Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110216001217 UT Part A Provider - Hospital 3375724826 Practice locations: Salt Lake City, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144526997. Details of each certification follow.

Hospital certification: CCN 464012

Legal name
SUCCESSOR HEALTHCARE LLC
Doing business as
MARIAN CENTER
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Nov 7, 2002
Last certification
Dec 9, 2014
Beds
14
Ownership / control type
Private (for profit)
Most recent change of ownership
Feb 1, 2011 (1 total)
Organization structure
LLCProprietary
Incorporated
Dec 8, 2010 in NV
Enrollment address
451 E Bishop Federal LN
Salt Lake City, UT 84115-2357
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospital

Medicare Care Compare
Listed as
Marian CenterCCN 464012 · All quality measures
Type
Psychiatric
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Successor Healthcare LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation, For-profit 5% Or Greater Indirect Ownership Interest Feb 1, 2011 100%
Ami Sato Individual Corporate OfficerTreasurer Successor Healthcare LLC Sep 9, 2024
Lee Allen Kilpack Individual W-2 Managing EmployeeAdministrator Jan 1, 2018
Operational/Managerial ControlAdministrator Jan 1, 2018
Milestone Healthcare LLC Organization, San Juan Capistrano, CA LLC 5% Or Greater Direct Ownership Interest Feb 1, 2011 100%
Tracy Jenkins Individual Corporate OfficerPresident Successor Healthcare LLC Sep 9, 2024
Tyler Hoopes Individual Corporate DirectorSole Manager Successor Healthcare Jan 1, 2019
Soon Burnam Individual Corporate OfficerSecretary Successor Healthcare LLC Feb 1, 2011

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St Joseph VillaSalt Lake City, UT, CCN 465095 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 1, 2016
Sep 16, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 6

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1296000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543795200000",
    "number": "1144526997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "451 EAST BISHOP FEDERAL LANE",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841152357",
            "telephone_number": "801-468-6856",
            "fax_number": "801-468-6850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "451 EAST BISHOP FEDERAL LANE",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841152357",
            "telephone_number": "801-468-6856",
            "fax_number": "801-468-6850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUCCESSOR HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-26",
        "last_updated": "2018-12-03",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "UT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marian Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Marian Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.