Provider Demographics
NPI:1013991256
Name:SORENSONS RANCH SCHOOL
Entity Type:Organization
Organization Name:SORENSONS RANCH SCHOOL
Other - Org Name:SORENSONS RESIDENTIAL TREATMENT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SORENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-638-7318
Mailing Address - Street 1:410 N 100 E
Mailing Address - Street 2:P.O. BOX 440219
Mailing Address - City:KOOSHAREM
Mailing Address - State:UT
Mailing Address - Zip Code:84744-7700
Mailing Address - Country:US
Mailing Address - Phone:435-638-7318
Mailing Address - Fax:435-638-7582
Practice Address - Street 1:410 N 100 E
Practice Address - Street 2:
Practice Address - City:KOOSHAREM
Practice Address - State:UT
Practice Address - Zip Code:84744-7700
Practice Address - Country:US
Practice Address - Phone:435-638-7318
Practice Address - Fax:435-638-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8393323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHS727PIMedicaid