Provider Demographics
NPI:1750948345
Name:MEADOW VALLEY MANAGEMENT LLC
Entity type:Organization
Organization Name:MEADOW VALLEY MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EVANGELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BODEN
Authorized Official - Suffix:
Authorized Official - Credentials:HFA
Authorized Official - Phone:801-393-2824
Mailing Address - Street 1:4390 S 700 W
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84405-3404
Mailing Address - Country:US
Mailing Address - Phone:801-393-2824
Mailing Address - Fax:801-479-5253
Practice Address - Street 1:4390 S 700 W
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:UT
Practice Address - Zip Code:84405-3404
Practice Address - Country:US
Practice Address - Phone:801-393-2824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility