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General NPI Number Information
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NPI Number | 1790638971
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Entity Type | Organization
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Legal Business Name | RENEW RECOVERY CENTER INC
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Dates
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Enumeration Date | 02/18/2026
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 260 FALLS AVE STE C
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City | TWIN FALLS
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State | ID
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Zip | 83301-3370
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Country | US
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Telephone | 208-329-6972
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Fax |
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Provider Business Mailing Address
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Address Line | 260 FALLS AVE STE C
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City | TWIN FALLS
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State | ID
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Zip | 83301-3370
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Country | US
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Telephone | 208-329-6972
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. BLAKE NIKLAS BRIXTON
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Credential |
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Telephone | 208-749-4317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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