Healthcare Provider Details

I. General information

NPI: 1366449860
Provider Name (Legal Business Name): KM BOYER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 EAST CENTER STREET
SPANISH FORK UT
84660-1802
US

IV. Provider business mailing address

PO BOX 606
SPANISH FORK UT
84660-0606
US

V. Phone/Fax

Practice location:
  • Phone: 801-798-6220
  • Fax: 801-794-1824
Mailing address:
  • Phone: 801-798-6220
  • Fax: 801-794-1824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. KIRK D. BOYER I
Title or Position: PRESIDENT/ADMINISTRATOR
Credential:
Phone: 801-798-6220