Provider Demographics
NPI:1336144153
Name:CANYONLANDS HEALTH CARE SPECIAL SERVICE DISTRICT
Entity Type:Organization
Organization Name:CANYONLANDS HEALTH CARE SPECIAL SERVICE DISTRICT
Other - Org Name:PARKWAY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-628-1480
Mailing Address - Street 1:55 SOUTH PROFESSIONAL WAY
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651
Mailing Address - Country:US
Mailing Address - Phone:801-465-9211
Mailing Address - Fax:801-465-1052
Practice Address - Street 1:55 SOUTH PROFESSIONAL WAY
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651
Practice Address - Country:US
Practice Address - Phone:801-465-9211
Practice Address - Fax:801-465-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT328890-1501314000000X
UT314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========010Medicaid
UT=========010Medicaid