MEDALLION SUPPORTED LIVING-SPRINGVILLE (NPI# 1851722904) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851722904 |
| Entity Type | Organization |
| Organization Name | MEDALLION SUPPORTED LIVING-SPRINGVILLE |
| Practice Address |
469 N Main St Springville UT 84663-1036 |
| Mailing Address |
Po Box 51377 Provo UT 84605-1377 |
| Practice Telephone | 8014912208 |
| Enumeration Date | 2013-11-27 |
| Last Update Date | 2013-11-27 |
| Authorized Official Name | MR. MERLIN MOYES (OWNER) |
| Authorized Official Telephone | 8013752710 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | 2013-SHCF-UT000620 | 05 |
| Street Address |
469 N MAIN ST |
| City | SPRINGVILLE |
| State | UT |
| Zip Code | 84663-1036 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851348965 | Hobble Creek Nursing & Rehab | Nursing Facility/Intermediate Care Facility | 469 N Main St, Springville, UT 84663-1036 | 2006-05-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659900835 | Change Academy At Lake of The Ozarks | Residential Treatment Facility, Emotionally Disturbed Children | 266 South Left Fork Hobble Creek Canyon Road, Springville, UT 84663 | 2020-04-08 |
| 1780215269 | Reboot Centers Hobble Creek | Clinical Neuropsychologist | 1154 Left Fork Hobble Creek Canyon Rd, Springville, UT 84663 | 2020-02-03 |
| 1063053866 | Jesus Lopez | Clinic/Center | 1461 Archmore Loop, Springville, UT 84663 | 2019-10-02 |
| 1689109506 | Cd Pharmacy LLC | Pharmacy | 863 W 450 S, Suite 201, Springville, UT 84663 | 2017-04-28 |
| 1215479225 | Jaydynn Cusworth | Behavior Technician | 692 S 2800 W Unit I 101, Springville, UT 84663 | 2016-11-08 |
| 1245699602 | Pamela Jamison | Speech-Language Pathologist | 1072 Wildflower Way, Springville, UT 84663 | 2016-02-14 |
| 1013397348 | Lindsay Erickson | Counselor | 470 Buckley Ave, Springville, UT 84663 | 2015-06-02 |
| 1790084903 | Grant Lee Murdoch | Counselor | 1102 N 850 W, Springville, UT 84663 | 2011-03-28 |
| 1306148739 | Siuta Sonny Faaootoa | Counselor | 551 North Main Street, Springville, UT 84663 | 2010-11-17 |
| 1891000790 | Christopher David Westover | Social Worker | 716 N 200 E, Springville, UT 84663 | 2010-08-16 |
| Find all providers in zip 84663 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295267219 | Iron County Care Center LLC | Intermediate Care Facility, Mentally Retarded | 69 East 100 South, Parowan, UT 84761-0397 | 2017-03-29 |
| 1043518145 | Medallion Supported Living-payson | Intermediate Care Facility, Mentally Retarded | 2192 W State Rd, Payson, UT 84651-4539 | 2011-03-14 |
| 1538179981 | Medallion Supported Living | Intermediate Care Facility, Mentally Retarded | 651 E 200 S, Lehi, UT 84043-9703 | 2006-08-08 |
| 1720098163 | Medallion Manor Inc. | Intermediate Care Facility, Mentally Retarded | 1701 W 600 S, Provo, UT 84601-3832 | 2006-08-08 |
| 1841241445 | Trinity Mission Wide Horizons Residential Care Facility, Lp | Intermediate Care Facility, Mentally Retarded | 910 Monroe Blvd, Ogden, UT 84404-6434 | 2006-05-16 |
| 1457318917 | Mesa Vista Inc | Intermediate Care Facility, Mentally Retarded | 394 W 400 N, Orem, UT 84057-4663 | 2006-04-27 |
| 1871570374 | West Jordan Care Center | Intermediate Care Facility, Mentally Retarded | 3350 W 7800 S, West Jordan, UT 84088-4506 | 2005-12-27 |
| 1396745378 | Rha Community Services of Utah | Intermediate Care Facility, Mentally Retarded | 642 University St, Salt Lake City, UT 84102-3213 | 2005-07-29 |
| 1245230820 | Rha Community Services of Utah | Intermediate Care Facility, Mentally Retarded | 645 S 1300 E, Salt Lake City, UT 84102-3206 | 2005-07-26 |
| 1598764862 | Provo Care Center | Intermediate Care Facility, Mentally Retarded | 256 E Center St, Provo, UT 84606-3107 | 2005-07-19 |
| Find all providers with the same taxonomy | ||||
| City | SPRINGVILLE |
| Zip Code | 84663 |
Please comment or provide details below to improve the information on MEDALLION SUPPORTED LIVING-SPRINGVILLE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.