Provider Demographics
NPI:1710105994
Name:KANE COUNTY HOSPITAL HUMAN RESOURCE SPECIAL SERVICE DISTRICT
Entity Type:Organization
Organization Name:KANE COUNTY HOSPITAL HUMAN RESOURCE SPECIAL SERVICE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SNF ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GRIFFITHS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:435-644-4159
Mailing Address - Street 1:355 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KANAB
Mailing Address - State:UT
Mailing Address - Zip Code:84741-3260
Mailing Address - Country:US
Mailing Address - Phone:435-644-4155
Mailing Address - Fax:435-644-4141
Practice Address - Street 1:355 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741-3260
Practice Address - Country:US
Practice Address - Phone:435-644-4155
Practice Address - Fax:435-644-4141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005-HOSP-425314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========003Medicaid
UT=========003Medicaid