Provider Demographics
NPI:1467511725
Name:NRA-DALEVILLE, INDIANA, LLC
Entity Type:Organization
Organization Name:NRA-DALEVILLE, INDIANA, LLC
Other - Org Name:U.S. RENAL CARE DALEVILLE DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-736-2700
Mailing Address - Street 1:5851 LEGACY CIR STE 900
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5982
Mailing Address - Country:US
Mailing Address - Phone:214-736-2700
Mailing Address - Fax:
Practice Address - Street 1:2220 E 59TH ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-3086
Practice Address - Country:US
Practice Address - Phone:765-378-1735
Practice Address - Fax:765-378-1744
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.S. RENAL CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-06
Last Update Date:2018-11-30
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
IN15D1056570OtherCLIA WAIVER
IN200881690AMedicaid
IN200881690AMedicaid