Healthcare Provider Details

I. General information

NPI: 1801831391
Provider Name (Legal Business Name): BEAVER VALLEY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5540 SOUTH 1050 EAST
S. OGDEN UT
84405
US

IV. Provider business mailing address

5540 SOUTH 1050 EAST
S. OGDEN UT
84405
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-8455
  • Fax: 801-479-1606
Mailing address:
  • Phone: 801-479-8455
  • Fax: 801-479-1606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2005-NCF-306
License Number StateUT

VIII. Authorized Official

Name: CRAIG VAL DAVIDSON
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 435-438-7100