Organization
RENAISSANCE RANCH
Active
Organization
RENAISSANCE RANCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID PINEGAR (EXECUTIVE DIRECTOR)
(208) 522-6155
Entity
Organization
Contact information
Practice address
1165 S UTAH AVE, IDAHO FALLS, ID 83402-3321
(208) 522-6155
Mailing address
1165 S UTAH AVE, IDAHO FALLS, ID 83402-3321
(208) 522-6155
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
—
—
Other
Enumeration date
04/18/2013
Last updated
04/18/2013
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