| Renaissance Ranch | |
|
4460 Central Way Pocatello ID 83202-5095 | |
| (208) 522-6155 | |
| (208) 522-6156 |
| Full Name | Renaissance Ranch |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 4460 Central Way, Pocatello, Idaho |
| Authorized Official Name and Position | David Pinegar (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2085226155 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Renaissance Ranch 1165 S Utah Ave Idaho Falls ID 83402-3321 Ph: (208) 522-6155 | Renaissance Ranch 4460 Central Way Pocatello ID 83202-5095 Ph: (208) 522-6155 |
| NPI Number | 1063820629 |
|---|---|
| Provider Enumeration Date | 07/28/2014 |
| Last Update Date | 07/28/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063820629 | NPI | - | NPPES |
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