Healthcare Provider Details

I. General information

NPI: 1215150867
Provider Name (Legal Business Name): RENVILLE COUNTY COMMUNITY RESIDENCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 GROVE AVE
BIRD ISLAND MN
55310-1174
US

IV. Provider business mailing address

831 GROVE AVE P.O.BOX 520
BIRD ISLAND MN
55310-1174
US

V. Phone/Fax

Practice location:
  • Phone: 320-365-3748
  • Fax:
Mailing address:
  • Phone: 320-365-3748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number802115
License Number StateMN

VIII. Authorized Official

Name: MISS BEVERLY BURMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 320-365-3748