Renaissance Ranch
NPI #1194169359 in Idaho Falls, Idaho
Provider Information
- NPI Number
- 1194169359
- Entity Type
- Organization
- Organization Name
- Renaissance Ranch
- Primary Specialty
- Clinic/Center - Rehabilitation, Substance Use Disorder
- Enumeration Date
- Apr 18, 2013
- Last Updated
- Apr 18, 2013
Practice Location
- Address
- 1165 S UTAH AVE
- City
- Idaho Falls
- State
- Idaho
- ZIP Code
- 83402-3321
- Phone
- (208) 522-6155
Authorized Official
- Name
- DAVID PINEGAR
- Title
- EXECUTIVE DIRECTOR
- Phone
- (208) 522-6155
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder) |
| Counselor - Mental Health — Mental Health |
| Clinic/Center - Rehabilitation, Substance Use Disorder — Rehabilitation, Substance Use Disorder |
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