- Enrollment id
- O20050503001274
- Enrollment state
- UT
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1174533590
- Multiple npi flag
- N
- Ccn
- 467038
- Associate id
- 2769376326
- Organization name
- BEAVER VALLEY HOSPITAL
- Doing business as name
- BEAVER VALLEY HOME HEALTH
- Incorporation date
- 1966-01-01
- Incorporation state
- UT
- Organization type structure
- GOVERNMENT
- Proprietary nonprofit
- N
- Address line 1
- 1109 N 100 W
- City
- BEAVER
- State
- UT
- Zip code
- 847137746