Provider Demographics
NPI:1982146767
Name:RELIANT RENAL CARE - EPHRATA,LLC
Entity type:Organization
Organization Name:RELIANT RENAL CARE - EPHRATA,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:KILROY
Authorized Official - Last Name:KILROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-744-2040
Mailing Address - Street 1:1400 N PROVIDENCE RD
Mailing Address - Street 2:BLD 2 SUITE 1040
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:804 GRANDVIEW DR
Practice Address - Street 2:SUITE 2
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1681
Practice Address - Country:US
Practice Address - Phone:610-744-2040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELIANT RENAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment