Provider Demographics
NPI:1619206661
Name:RENNES ASSISTED LIVING CORP.
Entity Type:Organization
Organization Name:RENNES ASSISTED LIVING CORP.
Other - Org Name:RENAISSANCE - WISCONSIN RAPIDS
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 1:1500 PEPPER AVE
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-6417
Mailing Address - Country:US
Mailing Address - Phone:715-424-6500
Mailing Address - Fax:
Practice Address - Street 1:1500 PEPPER AVE
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-6417
Practice Address - Country:US
Practice Address - Phone:715-424-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13051310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility