Provider Demographics
NPI:1992059687
Name:KANDIYOHI-RENVILLE COMMUNITY HEALTH BOARD
Entity type:Organization
Organization Name:KANDIYOHI-RENVILLE COMMUNITY HEALTH BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHB ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRUNS
Authorized Official - Suffix:
Authorized Official - Credentials: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:56277-1374
Mailing Address - Country:US
Mailing Address - Phone:320-523-3723
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:56277-1374
Practice Address - Country:US
Practice Address - Phone:320-523-3723
Practice Address - Fax:320-523-3749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare