MEDALLION MANOR INC.
Intermediate Care Facility, Mentally Retarded
Provo, Utah
Provider NPI: 1720098163
Organization Information:Organization Name: MEDALLION MANOR INC.
Practice Location:
1701 W 600 S PROVO, UT 84601 US
Tel: 801-375-2710 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Practice Location:
1701 W 600 S PROVO, UT 84601 US
Tel: 801-375-2710 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 315P00000X | Nursing & Custodial Care Facilities Intermediate Care Facility, Mentally Retarded | UT | 2006-NCF-69 |