MEDALLION SUPPORTED LIVING-PAYSON NPI 1043518145

NPI Information

MEDALLION SUPPORTED LIVING-PAYSON is an intermediate care facility mentally retarded in Payson, UT. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. MEDALLION SUPPORTED LIVING-PAYSON NPI is 1043518145. The provider is registered as an organization entity type.
The provider Is Doing Business As Medallion Manor Inc.

The provider's business location address is:

2192 W STATE RD
PAYSON, UT
ZIP 84651-539
Phone: (801) 375-2710
Fax: (801) 377-3651

The provider's authorized official is Merlin Moyes .
The authorized official title is Owner and has the following contact phone number (801) 375-2710.

The CLIA number assigned to this NPI record is 46D2197363 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/14/2011 and was last updated on 3/14/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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