Provider Demographics
NPI:1780159194
Name:ARLETA SHERWOOD PARK OPERATIONS LLC
Entity type:Organization
Organization Name:ARLETA SHERWOOD PARK OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-899-5364
Mailing Address - Street 1:31351 RANCHO VIEJO RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4062 ARLETA AVE NE
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4758
Practice Address - Country:US
Practice Address - Phone:503-390-2271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility