Organization
THRONE OF GRACE, LLC.
Active
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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