MEDICARE: COUNTRY VIEW MANOR INC

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	:	1962543355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTRY VIEW MANOR INC

Provider Business Mailing Address
First Line	:	2901 W CENTER ST
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84601-3659
Country	:	US
Telephone Number	:	801-373-5079
Fax Number	:	801-374-2855

Provider Business Practice Location Address
First Line	:	2901 W CENTER ST
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84601-3659
Country	:	US
Telephone Number	:	801-373-5079
Fax Number	:	801-374-2855

Authorized Official
Title or Position	:	CEO
Name	:	BRYAN ERICKSON
Credential	:
Telephone Number	:	801-763-5040

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	03/01/2010

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Directions to “COUNTRY VIEW MANOR INC ” Practice Location

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