1013991256 NPI number — SORENSONS RANCH SCHOOL

Table of content: (NPI 1013991256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013991256 NPI number — SORENSONS RANCH SCHOOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SORENSONS RANCH SCHOOL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013991256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 N 100 E
Provider Second Line Business Mailing Address:
P.O. BOX 440219
Provider Business Mailing Address City Name:
KOOSHAREM
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84744-7700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-638-7318
Provider Business Mailing Address Fax Number:
435-638-7582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 N 100 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KOOSHAREM
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84744-7700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-638-7318
Provider Business Practice Location Address Fax Number:
435-638-7582
Provider Enumeration Date:
12/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SORENSON
Authorized Official First Name:
SHANE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
435-638-7318

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X , with the licence number:  8393 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HS727PI , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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