Renaissance Ranch Idaho

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

RENAISSANCE RANCH IDAHO

Practice address

1275 N 400 E Apt F
Rupert, ID 83350-8549

Phone

(801) 545-0406

NPI assigned

Apr 8, 2024

Organization subpart

Yes

Parent organization

AWAKENING BEHAVIORAL HEALTHAs reported in NPPES

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

Authorized official

Name

Elly Golesh

Title

Administration

Phone

(385) 321-0244

Specialties & licenses 1

Addresses

Other names 1

• Renaissance Ranch Doing business as

Tax ID family

Renaissance Ranch Heyburn2 organizations share this tax ID, including this one

Part of

Renaissance Ranch Heyburn

Other organizations with this tax ID 1

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

• Renaissance Ranch Heyburn

  • Substance Abuse Rehabilitation Facility
  • Heyburn, ID
  • NPI 1114692373
  NPD tax ID

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

{
    "created_epoch": "1712534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712534400000",
    "number": "1801649090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2973 W 13800 S",
            "city": "BLUFFDALE",
            "state": "UT",
            "postal_code": "840658202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 N 400 E APT F",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833508549",
            "telephone_number": "801-545-0406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAISSANCE RANCH IDAHO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AWAKENING BEHAVIORAL HEALTH",
        "enumeration_date": "2024-04-08",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A",
        "authorized_official_last_name": "GOLESH",
        "authorized_official_first_name": "ELLY",
        "authorized_official_title_or_position": "ADMINISTRATION",
        "authorized_official_telephone_number": "385-321-0244"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renaissance Ranch",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Progressive Behavior Systems PA
• Progressive Behavior Systems PA
• Progressive Behavior Systems PA
• Progressive Behavior Systems, PA
• Quest Behavioral Health LLC
• Tanner Rencher, DDS
• Ridley'S Family Markets, Inc
• William Robar, DO
• Rupert Medical Center Partnership
• Margo Saunders, M.D.

• All providers in Rupert, ID
• Substance Abuse Rehabilitation Facility in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2024; 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.