West Jordan Care Center

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

2004-NCF-470 Issued in UT

Legal business name

WEST JORDAN CARE CENTER

Practice address

3350 W 7800 S
West Jordan, UT 84088-4506

Phone

(801) 282-0686

Fax

(801) 282-9767

NPI assigned

Dec 27, 2005

Last updated

Aug 22, 2020By 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

Mr. Gary M. Kelso

Title

President

Phone

(801) 389-1523

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871570374. Details of each certification follow.

• CCN 46G011 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 46G011

Legal name

WEST JORDAN CARE CENTER

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Feb 10, 1978

Last certification

Jul 2, 2025

Beds

82

Ownership / control type

Private (non-profit)

Facility address

3350 West 7800 South
West Jordan, UT 84088

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871570374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5007 S MISSION DR",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645059404",
            "telephone_number": "816-232-9573",
            "fax_number": "816-232-9596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 W 7800 S",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840884506",
            "telephone_number": "801-282-0686",
            "fax_number": "801-282-9767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST JORDAN CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KELSO",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-389-1523",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "UT",
            "license": "2004-NCF-470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "742561471031",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Intellectual Disabilities Intermediate Care Facility in West Jordan, UT
• Providers in West Jordan, UT by specialty
• Intellectual Disabilities Intermediate Care Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.