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		UT

General Provider Information

NPI Number	:	1962955237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAVER VALLEY HOSPITAL

Provider Business Mailing Address
First Line	:	4782 S HOLLADAY BLVD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5444
Country	:	US
Telephone Number	:	801-277-7002
Fax Number	:	801-272-0622

Provider Business Practice Location Address
First Line	:	4782 S HOLLADAY BLVD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5444
Country	:	US
Telephone Number	:	801-277-7002
Fax Number	:	801-272-0622

Authorized Official
Title or Position	:	TREASURER OF MANAGEMENT COMPANY
Name	:	SOON BURNAM
Credential	:
Telephone Number	:	949-540-1249

Provider Enumeration Date	:	08/03/2016
Last Update Date	:	03/02/2021

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Directions to “BEAVER VALLEY HOSPITAL ” Practice Location

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