- Enrollment id
- O20130612000323
- Enrollment state
- UT
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1205177722
- Multiple npi flag
- N
- Ccn
- 465181
- Associate id
- 9032358692
- Organization name
- AVALON CARE CENTER - VA PAYSON LLC
- Doing business as name
- MERVYN SHARP BENNION CENTRAL UTAH VETERANS HOME
- Incorporation date
- 2012-08-20
- Incorporation state
- UT
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MERVYN SHARP BENNION CENTRAL UTAH VETERANS HOME
- Affiliation entity name
- AVALON HEALTH CARE
- Affiliation entity id
- 57
- Address line 1
- 1551 N MAIN ST
- City
- PAYSON
- State
- UT
- Zip code
- 846515015