| NPI | 1881055861 |
|---|---|
| Doing Business As | RENAISSANCE RANCH OUTPATIENT OF LOGAN |
| Entity Type | Organization |
| Authorized Contact | SHEENA LINDHOLM Program Director 208-604-3872 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2019-09-13 |