Renewed Foundations LLC
Clinic/Center, Mental Health (Including Community Mental Health Center) in Idaho Falls, ID. Organization (NPI-2).
NPI number1548089261
StatusActive
Last updated in NPPESNov 4, 2024
Details
- NPI
- 1548089261
- Entity type
- Organization (NPI-2)
- Legal business name
- Renewed Foundations LLC
- Organization subpart
- No
- Enumeration date
- Oct 9, 2024
- Certification date
- Nov 4, 2024
- Last updated
- Nov 4, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
Practice location
725 S Woodruff Ave Ste 401Idaho Falls, ID 83401-5286
Phone 208-360-1886
Mailing address
382 Fire ThornIdaho Falls, ID 83404-4954
Phone 208-360-1886
Authorized official
Shawn Lapray
Ceo
2083601886
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