Provider Demographics
NPI:1306811393
Name:RENAL CARE OF WHITE OAK, LLC
Entity type:Organization
Organization Name:RENAL CARE OF WHITE OAK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-534-5102
Mailing Address - Street 1:407 LINCOLN RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3020
Mailing Address - Country:US
Mailing Address - Phone:305-534-5102
Mailing Address - Fax:305-673-1916
Practice Address - Street 1:1303 LINCOLN WAY
Practice Address - Street 2:SUITE A
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-1603
Practice Address - Country:US
Practice Address - Phone:412-673-1191
Practice Address - Fax:412-678-1746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2008-05-30
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
PA1014279800001Medicaid
PA1014279800001Medicaid