Provider Demographics
NPI:1194791046
Name:RENAL TREATMENT CENTERS NORTHEAST INC
Entity type:Organization
Organization Name:RENAL TREATMENT CENTERS NORTHEAST INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GROUP VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:USILTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:770-541-7922
Mailing Address - Street 1:5200 VIRGINIA WAY
Mailing Address - Street 2:STE 400
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7569
Mailing Address - Country:US
Mailing Address - Phone:615-320-4521
Mailing Address - Fax:866-594-2894
Practice Address - Street 1:700 W LEA BLVD
Practice Address - Street 2:G-2
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2541
Practice Address - Country:US
Practice Address - Phone:302-762-8585
Practice Address - Fax:302-762-8586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2008-06-10
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
DE000469434Medicaid
DE000469434Medicaid