NPIMap

Organization Active NPI

Moab Valley Healthcare, Inc.

Doing business as Moab Regional Recovery Center

  • Methadone Clinic
  • Moab, UT
National Provider Identifier
1285380394
Registry record updated Feb 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
MOAB VALLEY HEALTHCARE, INC.
Doing business as
Moab Regional Recovery Center
Practice address
382 W Care Campus Drive
Moab, UT 84532
Phone
(435) 719-3500
NPI assigned
Feb 28, 2022
Last updated
Feb 28, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
MOAB VALLEY HEALTHCARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 28, 2022

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

Authorized official

Name
Zach Wojcieszek
Title
Cfo
Phone
(435) 719-3558

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X Primary

Addresses

Primary practice location

382 W Care Campus Drive
Moab, UT 84532

Mailing address

450 Williams Way
Moab, UT 84532-2185

Other names 1

  • MOAB REGIONAL RECOVERY CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285380394. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Mar 21, 1997 in UT
Enrollment address
450 Williams Way
Moab, UT 84532-2185
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Moab Regional HospitalCCN 461302 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D2264602Moab Regional Recovery Center382 W Care Campus Dr, Moab, UT 84532Certificate of waiverJul 17, 2028

National Provider Directory

National Provider Directory
Part of
Amh Pro Fee Billing

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Zach Wojcieszek Individual Corporate OfficerCfo Jan 1, 2021
W-2 Managing Employee Jan 1, 2021
Moab Valley Healthcare, Inc. Organization, Moab, UT Non-profit Operational/Managerial Control May 22, 1995
Victoria Gigliotti Individual Corporate OfficerChief Clinical Officer Aug 1, 2001
Jennifer Sadoff Individual Corporate Officer Aug 1, 2015
Robert Farnsworth Individual Corporate Director May 1, 2014

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 58

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 58

Affiliated clinicians 111

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

View all 111

NPI Registry JSON

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

{
    "created_epoch": "1646006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646006400000",
    "number": "1285380394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 WILLIAMS WAY",
            "city": "MOAB",
            "state": "UT",
            "postal_code": "845322185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "382 W CARE CAMPUS DRIVE",
            "city": "MOAB",
            "state": "UT",
            "postal_code": "84532",
            "telephone_number": "435-719-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOAB VALLEY HEALTHCARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOAB VALLEY HEALTHCARE, INC.",
        "enumeration_date": "2022-02-28",
        "last_updated": "2022-02-28",
        "certification_date": "2022-02-15",
        "status": "A",
        "authorized_official_last_name": "WOJCIESZEK",
        "authorized_official_first_name": "ZACH",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "435-719-3558"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOAB REGIONAL RECOVERY CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moab, UT

Sources for this page

Verify at the official NPI Registry.