Renew Health Home and Home Medical Supply, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

RENEW HEALTH HOME AND HOME MEDICAL SUPPLY, LLC

Practice address

103 Pine St
Ste 103
Monticello, MN 55362-8564

Phone

(763) 295-6888

Fax

(763) 295-6777

NPI assigned

May 23, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Victor Kylochko

Title

Owner

Phone

(763) 295-6888

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1548263791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1603",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553621603",
            "telephone_number": "763-295-6888",
            "fax_number": "763-295-6777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 PINE ST",
            "address_2": "STE 103",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553628564",
            "telephone_number": "763-295-6888",
            "fax_number": "763-295-6777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEW HEALTH HOME AND HOME MEDICAL SUPPLY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KYLOCHKO",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-295-6888",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Monticello, MN
• Providers in Monticello, MN by specialty
• Durable Medical Equipment & Medical Supplies in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.