Organization
RECOVERY REFUGE COUNSELING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANENE E RAYNE LMSW (OWNER/ADMINISTRATOR)
(208) 859-6262
Entity
Organization
Contact information
Practice address
8100 W EMERALD ST STE 180, BOISE, ID 83704-9069
(208) 859-6262
(208) 567-2143
Mailing address
7070 N HILLGARD AVE, BOISE, ID 83714-7683
(208) 859-6262
(208) 567-2143
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LMSW-34242
SOCIAL WORK LICENSE
ID
01
—
M-6006
MEDICAL LICENCE
ID
Enumeration date
04/30/2019
Last updated
04/30/2019
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