Provider Demographics
NPI:1457858557
Name:RENNES ASSISTED LIVING CORP.
Entity Type:Organization
Organization Name:RENNES ASSISTED LIVING CORP.
Other - Org Name:THE RESIDENCE BY RENNES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-582-2200
Mailing Address - Street 1:261 FRENCH ST
Mailing Address - Street 2:
Mailing Address - City:PESHTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54157-1217
Mailing Address - Country:US
Mailing Address - Phone:715-582-2200
Mailing Address - Fax:
Practice Address - Street 1:1150 LOIS STREET
Practice Address - Street 2:
Practice Address - City:DEPERE
Practice Address - State:WI
Practice Address - Zip Code:54115
Practice Address - Country:US
Practice Address - Phone:920-983-5100
Practice Address - Fax:920-336-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI17321OtherCOMMUNITY-BASED RESIDENTIAL FACILITY LICENSE