NPIMap

Organization Active NPI

Throne of Grace, LLC.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Idaho Falls, ID
National Provider Identifier
1104173467
Registry record updated Dec 26, 2012
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.
Practice address
1165 S Utah Ave
Idaho Falls, ID 83402-3321
Phone
(208) 522-6155
Fax
(208) 522-6156
NPI assigned
Aug 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2012

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X ID Primary

Addresses

Primary practice location

1165 S Utah Ave
Idaho Falls, ID 83402-3321

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.

NPI Registry JSON

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

{
    "created_epoch": "1344211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356480000000",
    "number": "1104173467",
    "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": "1165 S UTAH AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023321",
            "telephone_number": "208-522-6155",
            "fax_number": "208-522-6156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THRONE OF GRACE, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-06",
        "last_updated": "2012-12-26",
        "status": "A",
        "authorized_official_last_name": "PINEGAR",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "208-522-6155"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renaissance Ranch",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2012; 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.