Provider Demographics
NPI:1902917651
Name:RENVILLE COUNTY
Entity Type:Organization
Organization Name:RENVILLE COUNTY
Other - Org Name:RENVILLE COUNTY PUBLIC HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRUNS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PHN
Authorized Official - Phone:320-523-3723
Mailing Address - Street 1:105 S 5TH ST
Mailing Address - Street 2:SUITE 119H
Mailing Address - City:OLIVIA
Mailing Address - State:MN
Mailing Address - Zip Code:56277-1375
Mailing Address - Country:US
Mailing Address - Phone:320-523-2570
Mailing Address - Fax:320-523-3749
Practice Address - Street 1:105 S 5TH ST
Practice Address - Street 2:SUITE 119H
Practice Address - City:OLIVIA
Practice Address - State:MN
Practice Address - Zip Code:56277-1375
Practice Address - Country:US
Practice Address - Phone:320-523-2570
Practice Address - Fax:320-523-3749
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENVILLE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
MN331319251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN080855500Medicaid
MN83-00091OtherMEDICA
MN114585OtherUCARE
MN2211AREOtherBCBS
MN2091221200OtherPRIME WEST
MN8G538REOtherBLUE PLUS
MN91562OtherHEALTH PARTNERS
MN114585OtherUCARE