Healthcare Provider Details

I. General information

NPI: 1861878266
Provider Name (Legal Business Name): BEAVER VALLEY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 08/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5540 S 1050 E
SOUTH OGDEN UT
84405-7078
US

IV. Provider business mailing address

100 E SAN MARCOS BLVD SUITE 200
SAN MARCOS CA
92069-2986
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-8455
  • Fax:
Mailing address:
  • Phone: 760-471-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2015-NCF-306
License Number StateUT

VIII. Authorized Official

Name: TOBY TILFORD
Title or Position: CEO/PRESIDENT
Credential:
Phone: 760-471-0388