Provider Demographics
NPI:1366449860
Name:KM BOYER LLC
Entity Type:Organization
Organization Name:KM BOYER LLC
Other - Org Name:SPANISH FORK NURSING & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:801-798-6220
Mailing Address - Street 1:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-0606
Mailing Address - Country:US
Mailing Address - Phone:801-798-6220
Mailing Address - Fax:801-794-1824
Practice Address - Street 1:151 EAST CENTER STREET
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1802
Practice Address - Country:US
Practice Address - Phone:801-798-6220
Practice Address - Fax:801-794-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT465183Medicare Oscar/Certification