Renewed Life Center, LLC

NPI #1780877456 in Nampa, Idaho

Provider Information

NPI Number: 1780877456
Entity Type: Organization
Organization Name: Renewed Life Center, LLC
Primary Specialty: Clinic/Center - Adult Mental Health
Enumeration Date: Aug 24, 2007
Last Updated: Jun 24, 2010

Practice Location

Address: 410 N. KINGS RD.
Address 2: SUITE 3
City: Nampa
State: Idaho
ZIP Code: 83687
Phone: (208) 467-4889

Authorized Official

Name: MR. ALAN ALAN NETTLES
Title: DIRECTOR
Phone: (208) 467-4889

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Case Management	251B00000X
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X
Clinic/Center - Adult Mental Health — Adult Mental Health	261QM0850X	Primary

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