Healthcare Provider Details

I. General information

NPI: 1780638759
Provider Name (Legal Business Name): SOUTH VALLEY HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3706 W 9000 S
WEST JORDAN UT
84088-8813
US

IV. Provider business mailing address

PO BOX 57850
MURRAY UT
84157-0850
US

V. Phone/Fax

Practice location:
  • Phone: 801-280-2273
  • Fax: 801-280-2285
Mailing address:
  • Phone: 801-268-1122
  • Fax: 801-268-1150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2005-NCF-83
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number2007-NCF-83
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number2007-NCF-83
License Number StateUT

VIII. Authorized Official

Name: CRAIG R JOHNSON
Title or Position: MEMBER
Credential:
Phone: 801-268-1122