Provider Demographics
NPI:1124121405
Name:RENAL CENTER OF SOMERVILLE, LLC
Entity type:Organization
Organization Name:RENAL CENTER OF SOMERVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-384-4090
Mailing Address - Street 1:1626 COLE BOULEVARD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3306
Mailing Address - Country:US
Mailing Address - Phone:303-384-4000
Mailing Address - Fax:720-497-9700
Practice Address - Street 1:1 ROUTE 206 NORTH
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-4143
Practice Address - Country:US
Practice Address - Phone:908-450-0396
Practice Address - Fax:908-450-0399
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENAL VENTURES MANAGMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-05
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23433261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0088391Medicaid
NJ312583Medicare Oscar/Certification