Basic Information
| Provider Information | |||||||||
| NPI: | 1720099229 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEAVER VALLEY HOSPITAL | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1670 | ||||||||
| Address2: | |||||||||
| City: | BEAVER | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847131670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4354387100 | ||||||||
| FaxNumber: | 4354387166 | ||||||||
| Practice Location | |||||||||
| Address1: | 1109 N 100 WEST | ||||||||
| Address2: | |||||||||
| City: | BEAVER | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847131670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4354387100 | ||||||||
| FaxNumber: | 4354387166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 04/24/2013 | ||||||||
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| AuthorizedOfficialLastName: | DAVIDSON | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
| AuthorizedOfficialMiddleName: | VAL | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4354387101 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 2005-HOSPICE-63766 | UT | Y | Agencies | Hospice Care, Community Based |
No ID Information.