Provider Demographics
NPI:1437586641
Name:RELIANT RENAL CARE BESSEMER HOME CHOICE LLC
Entity Type:Organization
Organization Name:RELIANT RENAL CARE BESSEMER HOME CHOICE LLC
Other - Org Name:RRC BESSEMER HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MC MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-287-7640
Mailing Address - Street 1:1400 N PROVIDENCE RD
Mailing Address - Street 2:BLD II SUITE 1040
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2043
Mailing Address - Country:US
Mailing Address - Phone:610-892-4700
Mailing Address - Fax:610-892-9760
Practice Address - Street 1:650 9TH AVE N.
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020
Practice Address - Country:US
Practice Address - Phone:610-892-4700
Practice Address - Fax:610-892-9760
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELIANT RENAL CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-02
Last Update Date:2016-05-17
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
AL01-2683Medicare PIN