NPI 1780037879

Summit Senior Living LLC

Organisation Preferred Provider Organization Kearns, UT

Practice location

Address: 5524 W 6200 S, Kearns, UT 84118-7925
Phone: (801) 520-3391
Mailing address: 201 NE Park Plaza Dr STE 105, Vancouver, WA 98684-5874

Authorised official

Name: Ronald Ziebart
Title: Manager
Phone: (503) 363-4636

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 2016ALIIUT000744 (UT)

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Registry record

NPI: 1780037879
Entity type: Organization
NPI issued: 13 Jul 2016
Record last updated: 13 Jul 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.