Provider Demographics
NPI:1942646328
Name:SHERWOOD HILLS RECOVERY RESORT
Entity Type:Organization
Organization Name:SHERWOOD HILLS RECOVERY RESORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-598-3417
Mailing Address - Street 1:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84339-0311
Mailing Address - Country:US
Mailing Address - Phone:801-598-3417
Mailing Address - Fax:
Practice Address - Street 1:7877 S HIGHWAY 89 # 91
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84339-9416
Practice Address - Country:US
Practice Address - Phone:801-598-3417
Practice Address - Fax:435-245-8328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT20809324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility