NPIMap

Organization Active NPI

Brick House Recovery

  • Substance Abuse Rehabilitation Facility
  • Meridian, ID
National Provider Identifier
1083150296
Registry record updated Jan 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
BRICK HOUSE RECOVERY
Practice address
1125 E Pine Ave
Meridian, ID 83642-5955
Phone
(208) 286-4274
NPI assigned
Jan 11, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2017

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

Authorized official

Name
Jason Douglas Coombs, MPC
Title
Executive Director/Owner
Phone
(801) 350-1716

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X ID
Substance Abuse Rehabilitation Facility 324500000X ID Primary

Addresses

Primary practice location

1125 E Pine Ave
Meridian, ID 83642-5955

Mailing address

1125 E Pine Ave
Meridian, ID 83642-5955
Phone (208) 286-4274

Other names 1

  • Renaissance Ranch Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Bear Tooth Laboratory LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1484092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484092800000",
    "number": "1083150296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 E PINE AVE",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425955",
            "telephone_number": "208-286-4274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 E PINE AVE",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425955",
            "telephone_number": "208-286-4274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRICK HOUSE RECOVERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-11",
        "last_updated": "2017-01-11",
        "status": "A",
        "authorized_official_last_name": "COOMBS",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR/OWNER",
        "authorized_official_telephone_number": "801-350-1716",
        "authorized_official_credential": "MPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renaissance Ranch",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Meridian, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2017; 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.