Basic Information
| Provider Information | |||||||||
| NPI: | 1710040795 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTH VALLEY HEALTHCARE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOLLADAY HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27101 PUERTA REAL | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926918518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494879500 | ||||||||
| FaxNumber: | 9495401966 | ||||||||
| Practice Location | |||||||||
| Address1: | 4782 HOLLADAY BLVD | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841175444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494879500 | ||||||||
| FaxNumber: | 9495403007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 06/03/2016 | ||||||||
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| AuthorizedOfficialLastName: | BURNAM | ||||||||
| AuthorizedOfficialFirstName: | SOON | ||||||||
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| AuthorizedOfficialTitleorPosition: | TREASURER OF MANAGEMENT COMPANY | ||||||||
| AuthorizedOfficialTelephone: | 9495401249 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 2007-NCF-78400 | UT | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.