Healthcare Provider Details

I. General information

NPI: 1902917651
Provider Name (Legal Business Name): RENVILLE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S 5TH ST SUITE 119H
OLIVIA MN
56277-1375
US

IV. Provider business mailing address

105 S 5TH ST SUITE 119H
OLIVIA MN
56277-1375
US

V. Phone/Fax

Practice location:
  • Phone: 320-523-2570
  • Fax: 320-523-3749
Mailing address:
  • Phone: 320-523-2570
  • Fax: 320-523-3749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number331319
License Number StateMN

VIII. Authorized Official

Name: MS. JILL L BRUNS
Title or Position: DIRECTOR
Credential: RN, PHN
Phone: 320-523-3723