| Organization Name: | RENAISSANCE RANCH OUTPATIENT TREATMENT |
| NPI Number: | 1710344585 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHERYL WACK (BILLING MANAGER) |
| Mailing Address: | 591 W 800 N Ste 202 Orem |
| State: | UT US |
| Postal Code: | 840573762 |
| Phone Number: | 8015724325 |
| Fax Number: | |
| NPI Enumeration Date: | 01/25/2016 |
| NPI Last Update Date: | 01/25/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 324500000X |
| License Number: | 4625 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |