Provider Demographics
NPI:1235907973
Name:RENEWED HORIZONS, LLC
Entity Type:Organization
Organization Name:RENEWED HORIZONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-704-8008
Mailing Address - Street 1:8252 N WAYNE DR
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-5029
Mailing Address - Country:US
Mailing Address - Phone:208-704-8008
Mailing Address - Fax:208-963-5641
Practice Address - Street 1:8252 N WAYNE DR
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-5029
Practice Address - Country:US
Practice Address - Phone:208-704-8008
Practice Address - Fax:208-963-5641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities