Medallion Manor Inc.

NPI #1720098163 in Provo, Utah

Provider Information

NPI Number: 1720098163
Entity Type: Organization
Organization Name: Medallion Manor Inc.
Primary Specialty: Intermediate Care Facility, Intellectual Disabilities
Enumeration Date: Aug 8, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 1701 W 600 S
City: Provo
State: Utah
ZIP Code: 84601-3832
Phone: (801) 375-2710

Authorized Official

Name: MR. MERLIN C MOYES
Title: ADMINISTRATOR
Phone: (801) 375-2710

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Intermediate Care Facility, Intellectual Disabilities	315P00000X	Primary

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