Healthcare Provider Details

I. General information

NPI: 1063346211
Provider Name (Legal Business Name): MOUNTAIN DIVISION - CVH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 N 200 E STE 2
NORTH LOGAN UT
84341-1944
US

IV. Provider business mailing address

1655 N 200 E STE 2
NORTH LOGAN UT
84341-1944
US

V. Phone/Fax

Practice location:
  • Phone: 435-713-9700
  • Fax:
Mailing address:
  • Phone: 435-713-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STACEY CRANDALL
Title or Position: CEO
Credential:
Phone: 435-713-9700