1942646328 NPI number — SHERWOOD HILLS RECOVERY RESORT

Table of content: (NPI 1942646328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942646328 NPI number — SHERWOOD HILLS RECOVERY RESORT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERWOOD HILLS RECOVERY RESORT
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:
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:
1942646328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 311
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLSVILLE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84339-0311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-598-3417
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7877 S HIGHWAY 89 # 91
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLSVILLE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84339-9416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-598-3417
Provider Business Practice Location Address Fax Number:
435-245-8328
Provider Enumeration Date:
05/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
JENSEN
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
801-598-3417

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  20809 , 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)





Copyright © 2007-2025 www.npivalidator.com