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General NPI Number Information
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NPI Number | 1942646328
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Entity Type | Organization
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Legal Business Name | SHERWOOD HILLS RECOVERY RESORT
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Dates
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Enumeration Date | 05/13/2013
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Last Update Date | 05/13/2013
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Provider Practice Location Address
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Address Line | 7877 S HIGHWAY 89 # 91
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City | WELLSVILLE
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State | UT
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Zip | 84339-9416
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Country | US
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Telephone | 801-598-3417
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Fax | 435-245-8328
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Provider Business Mailing Address
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Address Line | PO BOX 311
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City | WELLSVILLE
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State | UT
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Zip | 84339-0311
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Country | US
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Telephone | 801-598-3417
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | RONALD D. JENSEN
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Credential | LCSW
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Telephone | 801-598-3417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 20809
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License Number State | UT
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