| NPI | 1619412046 |
|---|---|
| Doing Business As | RENAISSANCE RANCH BLUFFDALE MEN'S PROGRAM, LLC |
| Doing Business As | RENAISSANCE RANCH TREATMENT CENTERS |
| Entity Type | Organization |
| Authorized Contact | KERRYLYNN BACA-PELPHREY Cco, Exec Dir Payor Relations 801-658-9646 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: UT 26066) |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility |
| Enumeration Date | 2016-12-20 |
| Last Update Date | 2020-03-30 |