Provider Demographics
NPI:1366676579
Name:RELIANT RENAL CARE WEST FLINT LLC
Entity Type:Organization
Organization Name:RELIANT RENAL CARE WEST FLINT LLC
Other - Org Name:RRC WEST FLINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP AND TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:G4007 CORUNNA RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4526
Mailing Address - Country:US
Mailing Address - Phone:610-892-4700
Mailing Address - Fax:610-892-9760
Practice Address - Street 1:G4007 CORUNNA RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:610-892-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELIANT RENAL CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-04
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment