- Enrollment id
- O20040811000897
- Enrollment state
- UT
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1720099229
- Multiple npi flag
- N
- Ccn
- 461544
- Associate id
- 2769376326
- Organization name
- BEAVER VALLEY HOSPITAL
- Doing business as name
- BEAVER VALLEY HOSPITAL HOSPICE
- Organization type structure
- GOVERNMENT
- Proprietary nonprofit
- N
- Address line 1
- 1109 N 100 W
- City
- BEAVER
- State
- UT
- Zip code
- 847137746