Provider Demographics
NPI:1174844237
Name:RAI CARE CENTERS OF ALABAMA LLC
Entity Type:Organization
Organization Name:RAI CARE CENTERS OF ALABAMA LLC
Other - Org Name:RAI-NORTH ST EAST-TALLADEGA
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JON
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUNDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-661-1100
Mailing Address - Street 1:1550 W. MCEWEN DRIVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1731
Mailing Address - Country:US
Mailing Address - Phone:615-661-1100
Mailing Address - Fax:615-507-3300
Practice Address - Street 1:805 NORTH ST E
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2529
Practice Address - Country:US
Practice Address - Phone:256-315-1662
Practice Address - Fax:256-315-1641
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAI II LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-11
Last Update Date:2011-08-02
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
AL012539Medicare Oscar/Certification