Healthcare Provider Details

I. General information

NPI: 1952416679
Provider Name (Legal Business Name): BEAVER VALLEY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 N 400 E
LOGAN UT
84341-7525
US

IV. Provider business mailing address

598 W 900 S STE 220
WOODS CROSS UT
84010-8195
US

V. Phone/Fax

Practice location:
  • Phone: 435-750-5501
  • Fax: 435-750-7031
Mailing address:
  • Phone: 801-397-4697
  • Fax: 801-397-4054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2006-NCF-482
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier870470782031
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name: TROY THOMPSON
Title or Position: BOARD PRESIDENT
Credential:
Phone: 801-397-4697