Provider Demographics
NPI:1952703472
Name:MOUNTAIN DIVISION - CVH, LLC
Entity Type:Organization
Organization Name:MOUNTAIN DIVISION - CVH, LLC
Other - Org Name:CACHE VALLEY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIVISION PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-568-5998
Mailing Address - Street 1:2380 N 400 E
Mailing Address - Street 2:
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-6000
Mailing Address - Country:US
Mailing Address - Phone:435-713-9700
Mailing Address - Fax:435-713-9589
Practice Address - Street 1:2380 N 400 E
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-6000
Practice Address - Country:US
Practice Address - Phone:435-713-9700
Practice Address - Fax:435-713-9589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT460054Medicare Oscar/Certification