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General NPI Number Information
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NPI Number | 1780638759
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Entity Type | Organization
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Legal Business Name | SOUTH VALLEY HEALTH CENTER, LLC
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 01/17/2008
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Provider Practice Location Address
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Address Line | 3706 W 9000 S
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City | WEST JORDAN
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State | UT
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Zip | 84088-8813
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Country | US
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Telephone | 801-280-2273
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Fax | 801-280-2285
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Provider Business Mailing Address
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Address Line | PO BOX 57850
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City | MURRAY
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State | UT
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Zip | 84157-0850
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Country | US
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Telephone | 801-268-1122
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Fax | 801-268-1150
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Authorized Official
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Title or Position | MEMBER
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Name | CRAIG R JOHNSON
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Credential |
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Telephone | 801-268-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number | 2007-NCF-83
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 2007-NCF-83
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2005-NCF-83
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License Number State | UT
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