Healthcare Provider Details

I. General information

NPI: 1336692698
Provider Name (Legal Business Name): BEAVER VALLEY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 E 300 N
PRICE UT
84501-2707
US

IV. Provider business mailing address

1340 E 300 N
PRICE UT
84501-2707
US

V. Phone/Fax

Practice location:
  • Phone: 435-637-9213
  • Fax: 435-637-4976
Mailing address:
  • Phone: 435-637-9213
  • Fax: 435-637-4976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateUT

VIII. Authorized Official

Name: SOON BURNAM
Title or Position: TREASURER OF MANAGEMENT COMPANY
Credential:
Phone: 949-540-1249