NPIMap

Organization Active NPI

Central Valley Medical Center

Doing business as Central Valley Home Health

  • Home Health Agency
  • Nephi, UT
National Provider Identifier
1104978790
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
467034 Issued in UT
Legal business name
CENTRAL VALLEY MEDICAL CENTER
Doing business as
Central Valley Home Health
Practice address
152 West 1500 North
Nephi, UT 84648
Phone
(435) 623-3050
Fax
(435) 623-3059
NPI assigned
Jan 17, 2007
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Shauna L. Archibald, R.N.
Title
Executive Director
Phone
(435) 623-3050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 467034 UT Primary

Addresses

Primary practice location

152 West 1500 North
Nephi, UT 84648

Mailing address

152 West 1500 North
Nephi, UT 84648
Phone (435) 623-3050

Other names 1

  • Central Valley Home Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050628000411 UT Part A Provider - Home Health Agency 2668380460 Practice locations: Nephi, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104978790. Details of each certification follow.

Home health agency certification: CCN 467034

Legal name
CENTRAL VALLEY MEDICAL CENTER
Doing business as
CENTRAL VALLEY HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Nov 16, 1984
Last certification
Oct 25, 2018
Ownership / control type
Proprietary
Organization structure
CorporationNon-profit
Incorporated
Feb 15, 1984 in UT
Enrollment address
152 W 1500 N
Nephi, UT 84648-5520

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Central Valley Home HealthCCN 467034 · All quality measures
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
Nov 16, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Brian Kartchner7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/26081706-bf97-4a1b-96e4-2d82c3343f85/

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mark R. Stoddard Individual Corporate OfficerCeo Feb 15, 1984
Corporate DirectorCeo Feb 15, 1984
Operational/Managerial ControlCeo Feb 15, 1984
Robert James Guillory Individual Corporate OfficerDirector Home Health May 1, 2017
Operational/Managerial ControlDirector Home Health May 1, 2017
Alan Kenison Individual Corporate OfficerBoard Member Jan 1, 2000
Corporate DirectorChairman Jan 13, 2010
Wendell Brent Davis Individual Corporate OfficerCfo Aug 15, 2016
Corporate DirectorCfo Aug 15, 2016
W-2 Managing EmployeeCfo Aug 15, 2016
Operational/Managerial ControlCfo Aug 16, 2016
Mark Chase Individual Corporate DirectorBoard Member Jan 1, 2000
Timothy M Blackham Individual Corporate DirectorBoard Member Apr 11, 2018
Leanna Lundell Individual Corporate DirectorBoard Member Apr 11, 2018
Sue Ann Whitlock Individual Corporate DirectorBoard Member Apr 11, 2018

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Central Valley Medical CenterNephi, UT, CCN 461304 Hospital Operational/Managerial Control Jan 1, 1985
Central Valley HospiceNephi, UT, CCN 461526 Hospice 5% Or Greater Direct Ownership Interest Feb 21, 2003

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Affiliated clinicians 9

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1104978790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "152 WEST 1500 NORTH",
            "city": "NEPHI",
            "state": "UT",
            "postal_code": "84648",
            "telephone_number": "435-623-3050",
            "fax_number": "435-623-3050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 WEST 1500 NORTH",
            "city": "NEPHI",
            "state": "UT",
            "postal_code": "84648",
            "telephone_number": "435-623-3050",
            "fax_number": "435-623-3059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL VALLEY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "ARCHIBALD",
        "authorized_official_first_name": "SHAUNA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "435-623-3050",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "UT",
            "license": "467034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Valley Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nephi, UT

Sources for this page

Verify at the official NPI Registry.