Basic Information
| Provider Information | |||||||||
| NPI: | 1548491525 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RCP DIALYSIS AT HOME LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 HOLLYWOOD BLVD | ||||||||
| Address2: | 300 N | ||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330216751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055120014 | ||||||||
| FaxNumber: | 8009861260 | ||||||||
| Practice Location | |||||||||
| Address1: | 4970 SW 52ND ST | ||||||||
| Address2: | SUITE 325 | ||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333145531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055120014 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2009 | ||||||||
| LastUpdateDate: | 08/07/2009 | ||||||||
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| AuthorizedOfficialLastName: | CLEMENTS | ||||||||
| AuthorizedOfficialFirstName: | JOAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 3055120014 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RENAL CAREPARTNERS INC | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BD1200X | FL | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Dialysis Equipment & Supplies |
No ID Information.