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Organization
MEDALLION SUPPORTED LIVING-SPRINGVILLE
Active
Organization
MEDALLION SUPPORTED LIVING-SPRINGVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MERLIN MOYES (OWNER)
(801) 375-2710
Entity
Organization
Contact information
Practice address
469 N MAIN ST, SPRINGVILLE, UT 84663-1036
(801) 491-2208
Mailing address
PO BOX 51377, PROVO, UT 84605-1377
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2013-SHCF-UT000620
—
UT
Enumeration date
11/27/2013
Last updated
11/27/2013
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