Organization
RENEWED LIFE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALAN ALAN NETTLES (DIRECTOR)
(208) 467-4889
Entity
Organization
Contact information
Practice address
410 N. KINGS RD., SUITE 3, NAMPA, ID 83687
(208) 467-4889
(208) 467-4499
Mailing address
410 N. KINGS RD., SUITE 3, NAMPA, ID 83687
(208) 467-4889
(208) 467-4499
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
08/24/2007
Last updated
06/24/2010
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