| NPI | 1104173467 |
|---|---|
| Doing Business As | RENAISSANCE RANCH |
| Entity Type | Organization |
| Authorized Contact | DAVID W PINEGAR Executive Director 208-522-6155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2012-12-26 |