Organization
RENAISSANCE RANCH HEYBURN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYSON BLAINE DIXON (OWNER)
(801) 860-0118
Entity
Organization
Contact information
Practice address
312 S 950 W, HEYBURN, ID 83336-9765
(855) 736-7262
Mailing address
312 S 950 W, HEYBURN, ID 83336-9765
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
08/10/2021
Last updated
08/10/2021
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