Organization
RENEWED HORIZONS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT GORDON HANSEN (ADMINISTRATOR)
(208) 704-8008
Entity
Organization
Contact information
Practice address
8252 N WAYNE DR, HAYDEN, ID 83835-5029
(208) 704-8008
Mailing address
8252 N WAYNE DR, HAYDEN, ID 83835-5029
(208) 704-8008
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
DDA-999
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DDA-999
—
ID
Enumeration date
11/18/2014
Last updated
12/12/2023
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