Healthcare Provider Details

I. General information

NPI: 1013991256
Provider Name (Legal Business Name): SORENSONS RANCH SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N 100 E
KOOSHAREM UT
84744-7700
US

IV. Provider business mailing address

410 N 100 E P.O. BOX 440219
KOOSHAREM UT
84744-7700
US

V. Phone/Fax

Practice location:
  • Phone: 435-638-7318
  • Fax: 435-638-7582
Mailing address:
  • Phone: 435-638-7318
  • Fax: 435-638-7582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number8393
License Number StateUT

VIII. Authorized Official

Name: STONE SORENSON
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 435-638-7318