Provider Demographics
NPI:1164456034
Name:RAI CARE CENTERS OF VIRGINIA I, LLC
Entity Type:Organization
Organization Name:RAI CARE CENTERS OF VIRGINIA I, LLC
Other - Org Name:RAI CARE CENTER GLOUCESTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:6740 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-5143
Mailing Address - Country:US
Mailing Address - Phone:804-695-2904
Mailing Address - Fax:804-693-1177
Practice Address - Street 1:6740 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-5143
Practice Address - Country:US
Practice Address - Phone:804-695-2904
Practice Address - Fax:804-693-1177
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-10
Last Update Date:2023-10-17
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
VA010399378Medicaid
VA201040OtherANTHEM BCBS
VA492646Medicare Oscar/Certification