Healthcare Provider Details

I. General information

NPI: 1922559285
Provider Name (Legal Business Name): RENEWED HOPE RANCH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 EAST 6000 NORTH
ENOCH UT
84721
US

IV. Provider business mailing address

425 EAST 6000 NORTH
ENOCH UT
84721
US

V. Phone/Fax

Practice location:
  • Phone: 435-531-0040
  • Fax: 888-487-6445
Mailing address:
  • Phone: 435-531-0040
  • Fax: 888-487-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number15745
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHEN C. BARRICK
Title or Position: OWNER/MANAGER
Credential: CMHC
Phone: 435-592-0558