Healthcare Provider Details

I. General information

NPI: 1669446563
Provider Name (Legal Business Name): CACHE VALLEY SPECIALTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 N 400 E
NORTH LOGAN UT
84341-1749
US

IV. Provider business mailing address

2380 N 400 E
NORTH LOGAN UT
84341-6000
US

V. Phone/Fax

Practice location:
  • Phone: 435-713-9700
  • Fax: 435-753-8005
Mailing address:
  • Phone: 435-713-9700
  • Fax: 435-753-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2005-HOSP-14503
License Number StateUT

VIII. Authorized Official

Name: DAVID S GEARY
Title or Position: CFO
Credential:
Phone: 435-713-9582