National Provider Identifier Database

RENAISSANCE RANCH
Rehabilitation, Substance Use Disorder


Contact Information

RENAISSANCE RANCH
1165 S UTAH AVE
IDAHO FALLS, ID83402-3321
Phone: 208-522-6155
Fax:
Website:
Specialty Taxonomy Code
* Rehabilitation, Substance Use Disorder 261QR0405X
Addiction (Substance Use Disorder) 101YA0400X
Mental Health 101YM0800X

* Indicates primary specialty

NPI Profile & details for RENAISSANCE RANCH

NPI Number 1194169359
Legal business name
LBN
RENAISSANCE RANCH
Authorized official DAVID PINEGAR - (EXECUTIVE DIRECTOR)
Entity Organization
Organization subpart No
Enumeration date 04/18/2013
Last updated 04/18/2013 - About 13 years ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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