Organization
MEDALLION SUPPORTED LIVING-PAYSON
Active
Other names
Medallion Manor Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MERLIN MOYES JR. (OWNER)
(801) 375-2710
Entity
Organization
Contact information
Practice address
2192 W STATE RD, PAYSON, UT 84651-4539
(801) 375-2710
(801) 377-3651
Mailing address
PO BOX 51377, PROVO, UT 84605-1377
(801) 375-2710
(801) 377-3651
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
2011-SHCF-100069
UT
Other
Enumeration date
03/14/2011
Last updated
03/14/2011
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