Healthcare Provider Details

I. General information

NPI: 1093337800
Provider Name (Legal Business Name): RENVILLE OLIVIA HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 12/05/2020
Certification Date: 12/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 W MAPLE AVE
OLIVIA MN
56277-1063
US

IV. Provider business mailing address

1003 W MAPLE AVE
OLIVIA MN
56277-1063
US

V. Phone/Fax

Practice location:
  • Phone: 320-523-1652
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: STEVEN ROHINSKY
Title or Position: PRESIDENT
Credential:
Phone: 320-523-1652