NPIMap

Organization Active NPI

Renaissance Ranch

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Idaho Falls, ID
National Provider Identifier
1194169359
Registry record updated Apr 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
RENAISSANCE RANCH
Practice address
1165 S Utah Ave
Idaho Falls, ID 83402-3321
Phone
(208) 522-6155
NPI assigned
Apr 18, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2013

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

Authorized official

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 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

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": "1366243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366243200000",
    "number": "1194169359",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAISSANCE RANCH",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-18",
        "last_updated": "2013-04-18",
        "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"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Apr 18, 2013; 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.