Provider Demographics
NPI:1083192215
Name:DCC, INC. DBA KIDNEY DIALYSIS AVOIDANCE PROGRAM
Entity Type:Organization
Organization Name:DCC, INC. DBA KIDNEY DIALYSIS AVOIDANCE PROGRAM
Other - Org Name:RENALOGIC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DIRECTOR, RISK MGMT & COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:KEA
Authorized Official - Middle Name:INGEBORG
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-594-3117
Mailing Address - Street 1:223 W JACKSON BLVD STE 604
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-6956
Mailing Address - Country:US
Mailing Address - Phone:623-594-3117
Mailing Address - Fax:602-714-8853
Practice Address - Street 1:223 W JACKSON BLVD STE 604
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-6956
Practice Address - Country:US
Practice Address - Phone:623-594-3117
Practice Address - Fax:602-714-8853
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DCC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-31
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management