Organization
RENEWED HORIZONS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SCOTT GORDON HANSEN (ADMINISTRATOR)
(208) 963-5645
Entity
Organization
Contact information
Practice address
8252 N WAYNE DR, HAYDEN, ID 83835-5029
(208) 963-5645
Mailing address
8252 N WAYNE DR, HAYDEN, ID 83835-5029
(208) 963-5645
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
RHA-5370
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RHA-5370
—
ID
Enumeration date
10/18/2016
Last updated
12/12/2023
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