NPIMap

Organization Active NPI

Throne of Grace, LLC.

Doing business as Renaissance Ranch

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Pocatello, ID
National Provider Identifier
1063820629
Registry record updated Jul 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
THRONE OF GRACE, LLC.
Doing business as
Renaissance Ranch
Practice address
4460 Central Way
Pocatello, ID 83202-5095
Phone
(208) 522-6155
Fax
(208) 522-6156
NPI assigned
Jul 28, 2014
Last updated
Jul 28, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. David Pinegar
Title
Executive Director
Phone
(208) 522-6155

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X ID Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X
Mental Health Counselor 101YM0800X

Addresses

Primary practice location

4460 Central Way
Pocatello, ID 83202-5095

Mailing address

1165 S Utah Ave
Idaho Falls, ID 83402-3321
Phone (208) 522-6155

Other names 1

  • Renaissance Ranch Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Renaissance Ranch3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4460 Central Way
Pocatello, ID 83202
Phone (208) 237-3991

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406505600000",
    "number": "1063820629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1165 S UTAH AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023321",
            "telephone_number": "208-522-6155",
            "fax_number": "208-522-6156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4460 CENTRAL WAY",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832025095",
            "telephone_number": "208-522-6155",
            "fax_number": "208-522-6156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THRONE OF GRACE, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-28",
        "last_updated": "2014-07-28",
        "status": "A",
        "authorized_official_last_name": "PINEGAR",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "208-522-6155",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "ID",
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renaissance Ranch",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.