Successor Healthcare LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

SUCCESSOR HEALTHCARE LLC

Practice address

451 Bishop Federal LN
Salt Lake City, UT 84115-2357

Phone

(801) 487-7557

Fax

(801) 487-1112

NPI assigned

Dec 21, 2010

Organization subpart

No

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

Authorized official

Name

Ms. Soon Burnam

Title

Treasurer of Management Company

Phone

(949) 540-1249

Specialties & licenses 2

Addresses

Other names 1

• St. Joseph Villa Doing business as

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• Successor Healthcare LLC

  • Psychiatric Hospital Unit
  • Salt Lake City, UT
  • NPI 1144526997

  3375724826

  Same PAC ID

All facility ownership & control disclosures 1

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

Owned or controlled facilities with NPI records 1

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

• Beaver Valley Hospital

  • Skilled Nursing Facility
  • Salt Lake City, UT
  • NPI 1477007524

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sonja J Bates, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Salt Lake City, UT
  • NPI 1699868950
  Medicare reassignment Care Compare group NPD
• David L Skalka Jr., NP-C

  • Nurse Practitioner
  • Salt Lake City, UT
  • NPI 1851692735
  Medicare reassignment Care Compare group NPD
• Willy Taylor, PA-C

  • Physician Assistant
  • Salt Lake City, UT
  • NPI 1437497849
  Medicare reassignment Care Compare group NPD
• Morgan Charles Galbraith, A.P.R.N.

  • Family Nurse Practitioner
  • Salt Lake City, UT
  • NPI 1285084525
  Medicare reassignment NPD

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

{
    "created_epoch": "1292889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464912000000",
    "number": "1255634879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "451 BISHOP FEDERAL LN",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841152357",
            "telephone_number": "801-487-7557",
            "fax_number": "801-487-1112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "451 BISHOP FEDERAL LN",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841152357",
            "telephone_number": "801-487-7557",
            "fax_number": "801-487-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUCCESSOR HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-21",
        "last_updated": "2016-06-03",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER OF MANAGEMENT COMPANY",
        "authorized_official_telephone_number": "949-540-1249",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "UT",
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "UT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Joseph Villa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Coco Suarez
• Melissa Suarez, PA-C
• Yumna Khalid Subhani, DDS
• Subtenant 1430 East 4500 South LLC
• Successor Healthcare LLC
• Successor Healthcare LLC
• Sydney Elaine Suckling, MD
• Brendan Jacob Sudberry
• Dallin Sudbury
• Mary C Suelflow

• Skilled Nursing Facility in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Skilled Nursing Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.