Provider Demographics
NPI:1447287669
Name:HIGH TOP RANCH SCHOOL
Entity type:Organization
Organization Name:HIGH TOP RANCH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SORENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-638-7411
Mailing Address - Street 1:PO BOX 440029
Mailing Address - Street 2:
Mailing Address - City:KOOSHAREM
Mailing Address - State:UT
Mailing Address - Zip Code:84744-0029
Mailing Address - Country:US
Mailing Address - Phone:435-638-7411
Mailing Address - Fax:435-638-7511
Practice Address - Street 1:2860 S. HWY 62
Practice Address - Street 2:
Practice Address - City:KOOSHAREM
Practice Address - State:UT
Practice Address - Zip Code:84744
Practice Address - Country:US
Practice Address - Phone:435-638-7411
Practice Address - Fax:435-638-7511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11645320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT788007789164Medicaid