Organization
BRICK HOUSE RECOVERY
Active
Other names
Renaissance Ranch
Organization subpart
No
Provider details
NPI number
Authorized official
JASON DOUGLAS COOMBS MPC (EXECUTIVE DIRECTOR/OWNER)
(801) 350-1716
Entity
Organization
Contact information
Practice address
1125 E PINE AVE, MERIDIAN, ID 83642-5955
(208) 286-4274
Mailing address
1125 E PINE AVE, MERIDIAN, ID 83642-5955
(208) 286-4274
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
ID
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
ID
Other
Enumeration date
01/11/2017
Last updated
01/11/2017
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