Summit Senior Living LLC

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

2016ALIIUT000744 Issued in UT

Legal business name

SUMMIT SENIOR LIVING LLC

Practice address

5524 W 6200 S
Kearns, UT 84118-7925

Phone

(801) 520-3391

NPI assigned

Jul 13, 2016

Last updated

Jul 13, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ronald Ziebart

Title

Manager

Phone

(503) 363-4636

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1468368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468368000000",
    "number": "1780037879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 NE PARK PLAZA DR STE 105",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986845874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5524 W 6200 S",
            "city": "KEARNS",
            "state": "UT",
            "postal_code": "841187925",
            "telephone_number": "801-520-3391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT SENIOR LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-13",
        "last_updated": "2016-07-13",
        "status": "A",
        "authorized_official_last_name": "ZIEBART",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "503-363-4636"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "UT",
            "license": "2016ALIIUT000744",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5524",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Preferred Provider Organization in Kearns, UT
• Providers in Kearns, UT by specialty
• Preferred Provider Organization in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.