Organization
RENAISSANCE RANCH IDAHO
Active
Parent organization
AWAKENING BEHAVIORAL HEALTH
Other names
Renaissance Ranch
Organization subpart
Yes
Provider details
NPI number
Legal business name
AWAKENING BEHAVIORAL HEALTH
Authorized official
ELLY GOLESH (ADMINISTRATION)
(385) 321-0244
Entity
Organization
Contact information
Practice address
1275 N 400 E APT F, RUPERT, ID 83350-8549
(801) 545-0406
Mailing address
2973 W 13800 S, BLUFFDALE, UT 84065-8202
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
04/08/2024
Last updated
04/08/2024
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