| Renaissance Ranch | |
|
1125 E Pine Ave Meridian ID 83642-5955 | |
| (208) 286-4274 | |
| Not Available |
| Full Name | Renaissance Ranch |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 1125 E Pine Ave, Meridian, Idaho |
| Authorized Official Name and Position | Jason Douglas Coombs (EXECUTIVE DIRECTOR/OWNER) |
| Authorized Official Contact | 8013501716 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Renaissance Ranch 1125 E Pine Ave Meridian ID 83642-5955 Ph: (208) 286-4274 | Renaissance Ranch 1125 E Pine Ave Meridian ID 83642-5955 Ph: (208) 286-4274 |
| NPI Number | 1083150296 |
|---|---|
| Provider Enumeration Date | 01/11/2017 |
| Last Update Date | 01/11/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083150296 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Idaho) | Secondary |
| 324500000X | Substance Abuse Rehabilitation Facility | (Idaho) | Primary |
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