Provider Demographics
NPI:1104919794
Name:RAI CARE CENTERS OF MARYLAND I, LLC
Entity type:Organization
Organization Name:RAI CARE CENTERS OF MARYLAND I, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUNDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-507-3307
Mailing Address - Street 1:1550 W. MCEWEN DRIVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1731
Mailing Address - Country:US
Mailing Address - Phone:615-661-1100
Mailing Address - Fax:615-507-3300
Practice Address - Street 1:5652 SILVER HILL ROAD
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-1145
Practice Address - Country:US
Practice Address - Phone:301-967-9891
Practice Address - Fax:301-967-6964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA184625OtherANTHEM VA BCBS
MD409585501Medicaid
DC037702500Medicaid
MD88170801OtherCAREFIRST BCBS
MD409585501Medicaid