Healthcare Provider Details

I. General information

NPI: 1780177980
Provider Name (Legal Business Name): RENVILLE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 ELM AVE E
HECTOR MN
55342-4501
US

IV. Provider business mailing address

801 NEVADA AVE STE 100
MORRIS MN
56267-1874
US

V. Phone/Fax

Practice location:
  • Phone: 320-848-2093
  • Fax:
Mailing address:
  • Phone: 320-589-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number30230
License Number StateMN

VIII. Authorized Official

Name: CURTIS BACH
Title or Position: CFO
Credential:
Phone: 320-589-4910