Healthcare Provider Details

I. General information

NPI: 1992059687
Provider Name (Legal Business Name): KANDIYOHI-RENVILLE COMMUNITY HEALTH BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S 5TH ST SUITE 119H
OLIVIA MN
56277-1374
US

IV. Provider business mailing address

105 S 5TH ST SUITE 119H
OLIVIA MN
56277-1374
US

V. Phone/Fax

Practice location:
  • Phone: 320-523-3723
  • Fax: 320-523-3749
Mailing address:
  • Phone: 320-523-3723
  • Fax: 320-523-3749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: JILL L BRUNS
Title or Position: CHB ADMINISTRATOR
Credential: PHN
Phone: 320-523-3723