Healthcare Provider Details

I. General information

NPI: 1043380991
Provider Name (Legal Business Name): KANE COUNTY HUMAN RESOURCE SPECIAL SERVICE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 N MAIN ST
KANAB UT
84741-3260
US

IV. Provider business mailing address

355 N MAIN ST
KANAB UT
84741-3260
US

V. Phone/Fax

Practice location:
  • Phone: 435-644-5811
  • Fax: 435-644-3588
Mailing address:
  • Phone: 435-644-5811
  • Fax: 435-644-3588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2005-HOSP-425
License Number StateUT

VIII. Authorized Official

Name: MS. SHERRIE ANN PANDYA
Title or Position: ADMINISTRATOR
Credential:
Phone: 435-644-5811