NPIMap

Organization Active NPI

Moab Valley Healthcare, Inc

Doing business as Moab Regional Hospital

  • Critical Access Hospital
  • Moab, UT
National Provider Identifier
1770513236
Registry record updated Dec 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
2005-HOSP-45117 Issued in UT
Legal business name
MOAB VALLEY HEALTHCARE, INC
Doing business as
Moab Regional Hospital
Practice address
450 W Williams Way
Moab, UT 84532-2065
Phone
(435) 719-3501
Fax
(435) 719-3509
NPI assigned
Jul 3, 2006
Last updated
Dec 12, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
MOAB VALLEY HEALTHCARE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 12, 2018

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

Authorized official

Name
Ms. Jennifer Sadoff
Title
Ceo
Phone
(435) 719-3514

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 2006-HOSPICE-926 UT
Critical Access Hospital 282NC0060X 2005-HOSP-45117 UT Primary
Children's Hospital 282NC2000X UT

Addresses

Primary practice location

450 W Williams Way
Moab, UT 84532-2065

Mailing address

450 W Williams Way
P.O.Box 998
Moab, UT 84532-0998
Phone (435) 719-3501

Other identifiers 2

IdentifierTypeStateIssuer
870391981011MedicaidUT
461518OtherUTHOSPICE MEDICARE

Other names 1

  • Moab Regional Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT5 enrollments
Opioid treatment program
Medicare-enrolled since Dec 27, 2023

Enrollment records 5

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
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
Practice locations: Moab, UT
O20071001000755 UT Part A Provider - Critical Access Hospital 2466361720 Receives reassigned benefits from 2 practitioners
Practice locations: Moab, UT
O20090421000058 UT Part A Provider - Hospice 2466361720 Practice locations: Moab, UT
O20240129004225 UT Part B Supplier - Opioid Treatment Program (Otp) 2466361720 Practice locations: Moab, UT

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1770513236. 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

Hospital certification: CCN 46Z302

Legal name
MOAB VALLEY HEALTHCARE, INC.
Doing business as
MOAB REGIONAL HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
May 22, 1995 in UT
Enrollment address
476 Williams Way B
Moab, UT 84532-2065
Other Hospital Practice Location

Hospice certification: CCN 461518

Legal name
MOAB VALLEY HEALTHCARE, INC.
Doing business as
GRAND COUNTY HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jul 14, 1998
Last certification
Feb 8, 2022
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
Jun 9, 1995 in UT
Enrollment address
450 Williams Way
Moab, UT 84532-2185

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

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Grand County HospiceCCN 461518 · All quality measures
Ownership
Non-Profit
Certified
Jul 14, 1998
Medicare certification status
ActiveFrom the Provider of Services file

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

National Provider Directory

National Provider Directory
Part of
Amh Pro Fee Billing

Locations

380 N 500 W
Ste 2
Moab, UT 84532
Phone (435) 259-7425

450 W Williams Way
Ste 1
Moab, UT 84532

450 W Williams Way
Ste B
Moab, UT 84532

476 W Williams Way
Ste A
Moab, UT 84532
Phone (435) 259-7121

Ownership & related parties

All disclosed owners & managing parties 6

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
Operational/Managerial Control May 22, 1995 100%
Operational/Managerial Control Nov 11, 2008
Victoria Gigliotti Individual Corporate OfficerChief Clinical Officer Aug 1, 2001
W-2 Managing Employee Jun 1, 2006
Jennifer Sadoff Individual Corporate Officer Aug 1, 2015
W-2 Managing Employee Aug 25, 2015
Robert Farnsworth Individual Corporate Director May 1, 2014
Suzanne Kirkham Individual Corporate Director May 1, 2014

Owners & managing parties with NPI records 1

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

Owned or controlled facilities with NPI records 1

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

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 97

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 97

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": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544572800000",
    "number": "1770513236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 W WILLIAMS WAY",
            "address_2": "P.O.BOX 998",
            "city": "MOAB",
            "state": "UT",
            "postal_code": "845320998",
            "telephone_number": "435-719-3501",
            "fax_number": "435-719-3509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 W WILLIAMS WAY",
            "city": "MOAB",
            "state": "UT",
            "postal_code": "845322065",
            "telephone_number": "435-719-3501",
            "fax_number": "435-719-3509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOAB VALLEY HEALTHCARE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOAB VALLEY HEALTHCARE, INC",
        "enumeration_date": "2006-07-03",
        "last_updated": "2018-12-12",
        "status": "A",
        "authorized_official_last_name": "SADOFF",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "435-719-3514",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "UT",
            "license": "2006-HOSPICE-926",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "UT",
            "license": "2005-HOSP-45117",
            "primary": true
        },
        {
            "code": "282NC2000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Children",
            "state": "UT",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870391981011",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOSPICE MEDICARE",
            "identifier": "461518",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moab Regional Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Moab Regional Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moab, UT

Sources for this page

Verify at the official NPI Registry.