NPIMap

Organization Active NPI

Renaissance Ranch Outpatient Treatment

  • Substance Abuse Rehabilitation Facility
  • Orem, UT
National Provider Identifier
1710344585
Registry record updated Jan 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
4625 Issued in UT
Legal business name
RENAISSANCE RANCH OUTPATIENT TREATMENT
Practice address
591 W 800 N Ste 202
Orem, UT 84057-3762
Phone
(801) 572-4325
NPI assigned
Jan 25, 2016
Organization subpart
Yes
Parent organization
RENAISSANCE RANCH OUTPATIENT TREATMENTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 25, 2016

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

Authorized official

Name
Cheryl Wack
Title
Billing Manager
Phone
(801) 381-2928

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 4625 UT Primary

Addresses

Primary practice location

591 W 800 N Ste 202
Orem, UT 84057-3762

Mailing address

591 W 800 N Ste 202
Orem, UT 84057-3762

Other names 1

  • Renaissance Ranch Outpatient - Orem Women Other name

National Provider Directory

National Provider Directory
Tax ID family
Renaissance Ranch Outpatient Treatment4 organizations share this tax ID, including this one
Part of
Renaissance Ranch Outpatient Treatment

Other organizations with this tax ID 3

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

Locations

591 W 800 N
Ste 202
Orem, UT 84057
Phone (801) 572-4325

NPI Registry JSON

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

{
    "created_epoch": "1453680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453680000000",
    "number": "1710344585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "591 W 800 N STE 202",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840573762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "591 W 800 N STE 202",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840573762",
            "telephone_number": "801-572-4325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAISSANCE RANCH OUTPATIENT TREATMENT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RENAISSANCE RANCH OUTPATIENT TREATMENT",
        "enumeration_date": "2016-01-25",
        "last_updated": "2016-01-25",
        "status": "A",
        "authorized_official_last_name": "WACK",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "801-381-2928"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "UT",
            "license": "4625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renaissance Ranch Outpatient - Orem Women",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Orem, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2016; 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.