| Renewed Foundations Llc | |
|
725 S Woodruff Ave Ste 401 Idaho Falls ID 83401-5286 | |
| (208) 360-1886 | |
| Not Available |
| Full Name | Renewed Foundations Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 725 S Woodruff Ave Ste 401, Idaho Falls, Idaho |
| Authorized Official Name and Position | Shawn Lapray (CEO) |
| Authorized Official Contact | 2083601886 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Renewed Foundations Llc 382 Fire Thorn Idaho Falls ID 83404-4954 Ph: (208) 360-1886 | Renewed Foundations Llc 725 S Woodruff Ave Ste 401 Idaho Falls ID 83401-5286 Ph: (208) 360-1886 |
| NPI Number | 1548089261 |
|---|---|
| Provider Enumeration Date | 10/09/2024 |
| Last Update Date | 11/04/2024 |
| Certification Date | 11/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548089261 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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