Provider Demographics
NPI:1023868338
Name:RURAL HUB PSYCHIATRY SERVICES MANAGEMENT COMPANY LLC
Entity type:Organization
Organization Name:RURAL HUB PSYCHIATRY SERVICES MANAGEMENT COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RENNELLS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, FNP-BC
Authorized Official - Phone:989-675-7910
Mailing Address - Street 1:8078 HOLLISTER RD
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-9230
Mailing Address - Country:US
Mailing Address - Phone:989-675-7910
Mailing Address - Fax:989-256-0767
Practice Address - Street 1:104 W EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2816
Practice Address - Country:US
Practice Address - Phone:989-675-7910
Practice Address - Fax:989-256-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty