Healthcare Provider Details

I. General information

NPI: 1760191480
Provider Name (Legal Business Name): SHERWOOD DETOX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8854 ZELZAH AVE
SHERWOOD FOREST CA
91325-2849
US

IV. Provider business mailing address

8854 ZELZAH AVE
SHERWOOD FOREST CA
91325-2849
US

V. Phone/Fax

Practice location:
  • Phone: 747-224-0708
  • Fax: 747-224-0709
Mailing address:
  • Phone: 747-224-0708
  • Fax: 747-224-0709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: EUGENE LUTSENKO
Title or Position: OWNER
Credential:
Phone: 818-300-4788