Provider Demographics
NPI:1285795443
Name:RELIANT RENAL CARE-COLORADO, LLC
Entity type:Organization
Organization Name:RELIANT RENAL CARE-COLORADO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEDNAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-892-4700
Mailing Address - Street 1:PO BOX 671661
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-1661
Mailing Address - Country:US
Mailing Address - Phone:610-892-4700
Mailing Address - Fax:610-892-9760
Practice Address - Street 1:400 BENEDICTA AVE
Practice Address - Street 2:C
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2099
Practice Address - Country:US
Practice Address - Phone:719-845-0003
Practice Address - Fax:719-845-0011
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELIANT RENAL CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-12
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0280261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
062549Medicare ID - Type Unspecified