Provider Demographics
NPI:1659525913
Name:CHOICE ONE RENAL CARE OF NEWARK, LLC
Entity Type:Organization
Organization Name:CHOICE ONE RENAL CARE OF NEWARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-495-8900
Mailing Address - Street 1:65 S TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1355
Mailing Address - Country:US
Mailing Address - Phone:740-522-2955
Mailing Address - Fax:740-522-2975
Practice Address - Street 1:65 S TERRACE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1355
Practice Address - Country:US
Practice Address - Phone:740-522-2955
Practice Address - Fax:740-522-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2009-06-23
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
IN362644Medicare Oscar/Certification