Organization
THRONE OF GRACE, LLC.
Active
Other names
Renaissance Ranch
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID PINEGAR (EXECUTIVE DIRECTOR)
(208) 522-6155
Entity
Organization
Contact information
Practice address
4460 CENTRAL WAY, POCATELLO, ID 83202-5095
(208) 522-6155
(208) 522-6156
Mailing address
1165 S UTAH AVE, IDAHO FALLS, ID 83402-3321
(208) 522-6155
(208) 522-6156
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
ID
Other
Enumeration date
07/28/2014
Last updated
07/28/2014
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