MEDICARE: BEAVER VALLEY HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1164651444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAVER VALLEY HOSPITAL

Provider Business Mailing Address
First Line	:	4285 HIGHLAND DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-2603
Country	:	US
Telephone Number	:	801-278-2839
Fax Number	:	801-272-6109

Provider Business Practice Location Address
First Line	:	4285 HIGHLAND DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-2603
Country	:	US
Telephone Number	:	801-278-2839
Fax Number	:	801-272-6109

Authorized Official
Title or Position	:	CFO
Name	:	TYLER MOSS
Credential	:
Telephone Number	:	435-438-7209

Provider Enumeration Date	:	07/08/2009
Last Update Date	:	02/15/2018

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Directions to “BEAVER VALLEY HOSPITAL ” Practice Location

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