Provider Demographics
NPI:1326294729
Name:REDROCK RENAL CARE LLC
Entity Type:Organization
Organization Name:REDROCK RENAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GALEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:BSBA
Authorized Official - Phone:702-586-0007
Mailing Address - Street 1:5751 S FORT APACHE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5624
Mailing Address - Country:US
Mailing Address - Phone:702-586-0007
Mailing Address - Fax:702-586-0009
Practice Address - Street 1:5751 S FORT APACHE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5624
Practice Address - Country:US
Practice Address - Phone:702-586-0007
Practice Address - Fax:702-586-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2000116.426261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment