Healthcare Provider Details

I. General information

NPI: 1336144153
Provider Name (Legal Business Name): CANYONLANDS HEALTH CARE SPECIAL SERVICE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SOUTH PROFESSIONAL WAY
PAYSON UT
84651
US

IV. Provider business mailing address

55 SOUTH PROFESSIONAL WAY
PAYSON UT
84651
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-9211
  • Fax: 801-465-1052
Mailing address:
  • Phone: 801-465-9211
  • Fax: 801-465-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number328890-1501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. RONALD KAPP
Title or Position: CEO
Credential:
Phone: 801-628-1480