Healthcare Provider Details

I. General information

NPI: 1366650343
Provider Name (Legal Business Name): BEAR RIVER VALLEY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W 600 N
TREMONTON UT
84337-2400
US

IV. Provider business mailing address

460 W 600 N
TREMONTON UT
84337-2400
US

V. Phone/Fax

Practice location:
  • Phone: 435-257-4400
  • Fax:
Mailing address:
  • Phone: 435-257-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number2007NCF24
License Number StateUT

VIII. Authorized Official

Name: ERIC PACKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 435-257-7441