Healthcare Provider Details

I. General information

NPI: 1023868338
Provider Name (Legal Business Name): RURAL HUB PSYCHIATRY SERVICES MANAGEMENT COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W EXCHANGE ST
OWOSSO MI
48867-2816
US

IV. Provider business mailing address

8078 HOLLISTER RD
LAINGSBURG MI
48848-9230
US

V. Phone/Fax

Practice location:
  • Phone: 989-675-7910
  • Fax: 989-256-0767
Mailing address:
  • Phone: 989-675-7910
  • Fax: 989-256-0767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNA RENNELLS
Title or Position: AUTHORIZED OFFICIAL
Credential: PMHNP-BC, FNP-BC
Phone: 989-675-7910