Provider Demographics
NPI:1659709061
Name:BEAVER VALLEY HOSPITAL
Entity Type:Organization
Organization Name:BEAVER VALLEY HOSPITAL
Other - Org Name:LITTLE COTTONWOOD REHABILITATION AND NURSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
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 1:3094 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-3834
Mailing Address - Country:US
Mailing Address - Phone:801-485-9007
Mailing Address - Fax:
Practice Address - Street 1:3094 S STATE ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-3834
Practice Address - Country:US
Practice Address - Phone:801-485-9007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility