Provider Demographics
NPI:1477704997
Name:RED ROCKS DIALYSIS LLC
Entity Type:Organization
Organization Name:RED ROCKS DIALYSIS LLC
Other - Org Name:U.S RENAL CARE ZUNI 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 1:2400 DALLAS PKWY
Mailing Address - Street 2:STE 350
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4370
Mailing Address - Country:US
Mailing Address - Phone:214-736-2700
Mailing Address - Fax:214-736-2701
Practice Address - Street 1:20 D AVE
Practice Address - Street 2:
Practice Address - City:ZUNI
Practice Address - State:NM
Practice Address - Zip Code:87327-4120
Practice Address - Country:US
Practice Address - Phone:505-782-5663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.S. RENAL CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-02
Last Update Date:2015-12-08
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
NM99487357Medicaid
NM99487357Medicaid