Renaissance Ranch

LBN: Throne Of Grace, Llc.
Renaissance Ranch is an health care organization with primary practice located at 4460 Central Way , Pocatello ID 83202-5095. The organization recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health, Ambulatory Health Care Facilities / Rehabilitation, Substance Use Disorder. Ambulatory Health Care Facilities / Rehabilitation, Substance Use Disorder is the primary health care specialty. Throne Of Grace, Llc. can be contacted via phone (208) 522-6155, or through Pinegar, David via phone (208) 522-6155.

Contact Information

Primary practice address
4460 Central Way Pocatello ID 83202-5095
Phone: (208) 522-6155
Fax: (208) 522-6156
Website:
Map and Directions
Authorized official contact:
Name: Pinegar, David
Phone: (208) 522-6155

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Ambulatory Health Care Facilities / Rehabilitation, Substance Use Disorder 261QR0405X Idaho

Profile Details

NPI number 1063820629
LBN Legal business name Throne Of Grace, Llc.
DBA Doing business as Renaissance Ranch
Authorized official Pinegar, David
Entity Organization
Organization subpart 1 No
Enumeration date Jul 28th, 2014
Last updated Jul 28th, 2014 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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