Provider Demographics
NPI:1548491525
Name:RCP DIALYSIS AT HOME LLC
Entity type:Organization
Organization Name:RCP DIALYSIS AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-512-0014
Mailing Address - Street 1:4000 HOLLYWOOD BLVD
Mailing Address - Street 2:300 N
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6751
Mailing Address - Country:US
Mailing Address - Phone:305-512-0014
Mailing Address - Fax:800-986-1260
Practice Address - Street 1:4970 SW 52ND ST
Practice Address - Street 2:SUITE 325
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-5531
Practice Address - Country:US
Practice Address - Phone:305-512-0014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENAL CAREPARTNERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332BD1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies