Provider Demographics
NPI:1093104184
Name:USRC CUYAHOGA FALLS, LLC
Entity Type:Organization
Organization Name:USRC CUYAHOGA FALLS, LLC
Other - Org Name:U.S. RENAL CARE CUYAHOGA FALLS DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-736-2700
Mailing Address - Street 1:PO BOX 844631
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4631
Mailing Address - Country:US
Mailing Address - Phone:870-931-5400
Mailing Address - Fax:870-931-5418
Practice Address - Street 1:421 PORTAGE TRL
Practice Address - Street 2:STE B
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3227
Practice Address - Country:US
Practice Address - Phone:330-928-7970
Practice Address - Fax:330-928-7680
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.S. RENAL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-13
Last Update Date:2017-03-30
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
OH0153675Medicaid
OH0153675Medicaid