Provider Demographics
NPI:1760191480
Name:SHERWOOD DETOX
Entity Type:Organization
Organization Name:SHERWOOD DETOX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTSENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-300-4788
Mailing Address - Street 1:8854 ZELZAH AVE
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8854 ZELZAH AVE
Practice Address - Street 2:
Practice Address - City:SHERWOOD FOREST
Practice Address - State:CA
Practice Address - Zip Code:91325-2849
Practice Address - Country:US
Practice Address - Phone:818-300-4788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA370189APOther191171AP