MEDALLION MANOR INC. NPI 1720098163

NPI Information

MEDALLION MANOR INC. is an intermediate care facility mentally retarded in Provo, UT. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. MEDALLION MANOR INC. NPI is 1720098163. The provider is registered as an organization entity type.

The provider's business location address is:

1701 W 600 S
PROVO, UT
ZIP 84601-832
Phone: (801) 375-2710

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

The CLIA number assigned to this NPI record is 46D0525403 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/8/2006 and was last updated on 8/22/2020.

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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