Moab Valley Healthcare, Inc.
Organization Active NPI Methadone Clinic · Moab, UT
NPI 1285380394 · NPPES record last updated Feb 28, 2022
Key facts
- NPI
- 1285380394
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Methadone Clinic 261QM2800X
- Legal business name
- MOAB VALLEY HEALTHCARE, INC.
- Practice address
- 382 W Care Campus Drive
Moab, UT 84532 - Phone
- (435) 719-3500
- NPI assigned
- Feb 28, 2022
- Organization subpart
- Yes
- Parent organization (as reported)
- MOAB VALLEY HEALTHCARE, INC.
Authorized official
- Name
- Zach Wojcieszek
- Title
- Cfo
- Phone
- (435) 719-3558
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 2
Other NPIs on the same Medicare enrollment 2
Related certifications (CCN) 1
Practitioners 58
-
Kristin Adams, L.C.S.W.
-
Janel Arbon, RD
-
Kathleen Joanne Bartczak, M.D.
-
Shyrlan Beck, PA-C
-
Emily F. Chin, DO
-
Kevin D. Christensen, M.D.
-
Laird Ian Clark, CRNA
-
Dylan Cole, D.O.
-
Paula Jane Cook, M.D.
-
Luke Allan Counterman, PA-C
-
Timothy Joseph Cristman, PA-C
-
Zoe Kathleen Cross, M.D.
-
Cheri Engberson, CSW
-
Riki Gifford-Ferguson, PA-C
-
Tori Helm, LCSW
-
Chelsi Eliza Hollingshead, APRN, PSYCHIATRIC/ME
-
Daniel Matthew Hoopes, M.D.
-
Christopher M Hull, M.D.
-
Paul Michael Johnson, M.D.
-
Philip A Kopell, MD
-
Marlana M. Li, M.D.
-
Eve Maher-Young, P.A.-C.
Affiliated clinicians 111
-
Kristin Adams, L.C.S.W.
-
Angela Alexander, MD
-
Ray Allen Andrew, M.D.
-
Kathleen Joanne Bartczak, M.D.
-
Richard Beutler, M.D.
-
Claire Bice, PA
-
Irene P.N. Cheong, DNP, APRN
-
Laird Ian Clark, CRNA
-
Dylan Cole, D.O.
-
Luke Allan Counterman, PA-C
-
Zoe Kathleen Cross, M.D.
-
Nicole Marie Fox, PA-C
-
Kimberly Franke, M.D.
-
Leo W Hardy, MD
-
Daniel Matthew Hoopes, M.D.
-
Paul Michael Johnson, M.D.
Medicare Care Compare: Hospital
- Listed as
- Moab Regional Hospital
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 46D2264602 | Moab Regional Recovery Center | Certificate of waiver | Jul 17, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in UT
Hospital certification: CCN 461302
- Legal name
- MOAB VALLEY HEALTHCARE, INC.
- Doing business as
- MOAB REGIONAL HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Apr 30, 2003
- Last certification
- Sep 15, 2022
- Beds
- 17
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 21, 1997 in UT
- Enrollment address
- 450 Williams Way
Moab, UT 84532-2185
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Zach Wojcieszek |
Corporate Officer |
Jan 1, 2021 | |
| W-2 Managing Employee | Jan 1, 2021 | ||
| Moab Valley Healthcare, Inc. |
Operational/Managerial Control | May 22, 1995 | |
| Victoria Gigliotti |
Corporate Officer |
Aug 1, 2001 | |
| Jennifer Sadoff |
Corporate Officer | Aug 1, 2015 | |
| Robert Farnsworth |
Corporate Director | May 1, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040114000346 | UT | Part B Supplier - Clinic/Group Practice | 2466361720 |
Receives reassigned benefits from 96 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Moab, UT |
| O20061104000120 | UT | Part a Provider - Critical Access Hospital | 2466361720 |
Receives reassigned benefits from 67 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Moab, UT |
National Provider Directory
- Part of
- Moab Valley Healthcare Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Methadone Clinic | 261QM2800X | Yes |
Addresses
Primary practice location
382 W Care Campus Drive
Moab, UT 84532
Mailing address
450 Williams Way
Moab, UT 84532-2185
Other names
- MOAB REGIONAL RECOVERY CENTER
Other providers in Moab, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.