Subtenant 1430 East 4500 South LLC

Primary specialty

Psychiatric HospitalTaxonomy code 283Q00000X

License

2011-HOSP-100053 Issued in UT

Legal business name

SUBTENANT 1430 EAST 4500 SOUTH LLC

Practice address

1430 East 4500 South
Salt Lake City, UT 84117-4208

Phone

(801) 272-8000

Fax

(801) 272-4983

NPI assigned

Jan 16, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Thomas V Croal

Title

SVP & Cfo

Phone

(949) 240-7200

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Aspen Park Rehabilitation Doing business as

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469491200000",
    "number": "1629129689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 OAK CANYON",
            "address_2": "200",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926185233",
            "telephone_number": "949-240-7200",
            "fax_number": "949-240-7270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 EAST 4500 SOUTH",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841174208",
            "telephone_number": "801-272-8000",
            "fax_number": "801-272-4983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUBTENANT 1430 EAST 4500 SOUTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2016-07-26",
        "status": "A",
        "authorized_official_last_name": "CROAL",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "SVP & CFO",
        "authorized_official_telephone_number": "949-240-7200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "UT",
            "license": "2011-HOSP-100053",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "UT",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "911982083003",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aspen Park Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nelithza Suamataia, BCBA
• Hugo Spencer Suarez-Bejarano, CPSS
• Coco Suarez
• Melissa Suarez, PA-C
• Yumna Khalid Subhani, DDS
• Successor Healthcare LLC
• Successor Healthcare LLC
• Successor Healthcare LLC
• Sydney Elaine Suckling, MD
• Brendan Jacob Sudberry

• Psychiatric Hospital in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Psychiatric Hospital in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.