Medallion Supported Living-Springville

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

MEDALLION SUPPORTED LIVING-SPRINGVILLE

Practice address

469 N Main St
Springville, UT 84663-1036

Phone

(801) 491-2208

NPI assigned

Nov 27, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Merlin Moyes

Title

Owner

Phone

(801) 375-2710

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851722904. Details of each certification follow.

• CCN 46G024 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 46G024

Legal name

MEDALLION SUPPORTED LIVING - SPRINGVILLE

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jan 15, 2014

Last certification

Jul 17, 2025

Beds

16

Ownership / control type

Private (proprietary)

Facility address

469 North Main Street
Springville, UT 84663

Tax ID family

Medallion Manor Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Medallion Manor Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Provo, UT
  • NPI 1720098163
  NPD tax ID
• Medallion Supported Living

  • Intellectual Disabilities Intermediate Care Facility
  • Lehi, UT
  • NPI 1538179981
  NPD tax ID
• Medallion Supported Living-Payson

  dba Medallion Manor Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Payson, UT
  • NPI 1043518145
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385510400000",
    "number": "1851722904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51377",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846051377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "469 N MAIN ST",
            "city": "SPRINGVILLE",
            "state": "UT",
            "postal_code": "846631036",
            "telephone_number": "801-491-2208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDALLION SUPPORTED LIVING-SPRINGVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-27",
        "last_updated": "2013-11-27",
        "status": "A",
        "authorized_official_last_name": "MOYES",
        "authorized_official_first_name": "MERLIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-375-2710",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2013-SHCF-UT000620",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brayden McBride, M.D.
• Annalisa McEwan
• Michael S McLay, M.D.
• Ian McMaster, M.D.
• Robert G McNutt
• Mending Minds Village
• Michael Darley MD Rheumatologist PLLC
• George H Michalek, M.D.
• Dale Mikesell
• Kierea Chanelle Miller, A.M.F.T.

• Intellectual Disabilities Intermediate Care Facility in Springville, UT
• Providers in Springville, UT by specialty
• Intellectual Disabilities Intermediate Care Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.