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General NPI Number Information
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NPI Number | 1063346211
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Entity Type | Organization
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Legal Business Name | MOUNTAIN DIVISION - CVH, LLC
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Dates
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Enumeration Date | 06/11/2026
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Last Update Date | 06/11/2026
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Provider Practice Location Address
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Address Line | 1655 N 200 E STE 2
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City | NORTH LOGAN
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State | UT
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Zip | 84341-1944
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Country | US
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Telephone | 435-713-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 1655 N 200 E STE 2
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City | NORTH LOGAN
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State | UT
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Zip | 84341-1944
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Country | US
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Telephone | 435-713-9700
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | STACEY CRANDALL
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Credential |
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Telephone | 435-713-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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