Organization
SOUTH VALLEY HEALTH CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG R JOHNSON (MEMBER)
(801) 268-1122
Entity
Organization
Contact information
Practice address
3706 W 9000 S, WEST JORDAN, UT 84088-8813
(801) 280-2273
(801) 280-2285
Mailing address
PO BOX 57850, MURRAY, UT 84157-0850
(801) 268-1122
(801) 268-1150
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2005-NCF-83
UT
332BN1400X
Nursing Facility Supplies (DME)
2007-NCF-83
UT
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
2007-NCF-83
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870439756007
—
UT
Enumeration date
05/22/2006
Last updated
01/17/2008
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