1437586641 NPI number — RELIANT RENAL CARE BESSEMER HOME CHOICE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437586641 NPI number — RELIANT RENAL CARE BESSEMER HOME CHOICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RELIANT RENAL CARE BESSEMER HOME CHOICE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437586641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 N PROVIDENCE RD
Provider Second Line Business Mailing Address:
BLD II SUITE 1040
Provider Business Mailing Address City Name:
MEDIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19063-2043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-892-4700
Provider Business Mailing Address Fax Number:
610-892-9760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 9TH AVE N.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BESSEMER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-892-4700
Provider Business Practice Location Address Fax Number:
610-892-9760
Provider Enumeration Date:
10/02/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MC MULLEN
Authorized Official First Name:
NOLA
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
307-287-7640

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)