Provider Demographics
NPI:1578939427
Name:BEAVER VALLEY HOSPITAL
Entity Type:Organization
Organization Name:BEAVER VALLEY HOSPITAL
Other - Org Name:SPANISH FORK REHABILITATION AND NURSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-709-4358
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 E CENTER ST
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-2161
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:2015-08-14
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT465183Medicare Oscar/Certification