NPIMap

Organization Active NPI

Renaissance Ranch Heyburn

  • Substance Abuse Rehabilitation Facility
  • Heyburn, ID
National Provider Identifier
1114692373
Registry record updated Aug 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
RENAISSANCE RANCH HEYBURN
Practice address
312 S 950 W
Heyburn, ID 83336-9765
Phone
(855) 736-7262
NPI assigned
Aug 10, 2021
Last updated
Aug 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2021

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

Authorized official

Name
Tyson Blaine Dixon
Title
Owner
Phone
(801) 860-0118

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

312 S 950 W
Heyburn, ID 83336-9765

Mailing address

312 S 950 W
Heyburn, ID 83336-9765

National Provider Directory

National Provider Directory
Tax ID family
Renaissance Ranch Idaho2 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 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1628553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628553600000",
    "number": "1114692373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 S 950 W",
            "city": "HEYBURN",
            "state": "ID",
            "postal_code": "833369765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 S 950 W",
            "city": "HEYBURN",
            "state": "ID",
            "postal_code": "833369765",
            "telephone_number": "855-736-7262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAISSANCE RANCH HEYBURN",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-10",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A",
        "authorized_official_last_name": "DIXON",
        "authorized_official_first_name": "TYSON",
        "authorized_official_middle_name": "BLAINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-860-0118"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Heyburn, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; 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.