Healthcare Provider Details

I. General information

NPI: 1023286739
Provider Name (Legal Business Name): RENNES THERAPY SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S 9TH ST
DE PERE WI
54115-1393
US

IV. Provider business mailing address

261 FRENCH ST
PESHTIGO WI
54157-1217
US

V. Phone/Fax

Practice location:
  • Phone: 920-336-5680
  • Fax:
Mailing address:
  • Phone: 715-582-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number525573
License Number StateWI

VIII. Authorized Official

Name: MR. TIMOTHY H RENNES
Title or Position: OWNER
Credential:
Phone: 715-582-2200