Provider Demographics
NPI:1801024096
Name:RENAL CARE GROUP MAPLEWOOD, LLC
Entity Type:Organization
Organization Name:RENAL CARE GROUP MAPLEWOOD, LLC
Other - Org Name:FRESENIUS MEDICAL CARE IRONBOUND
Other - Org Type:Doing Business As
Authorized Official - Title/Position: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 1:248 SOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07114-2911
Mailing Address - Country:US
Mailing Address - Phone:973-344-0655
Mailing Address - Fax:973-344-6966
Practice Address - Street 1:248 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114-2911
Practice Address - Country:US
Practice Address - Phone:973-344-0655
Practice Address - Fax:973-344-6966
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-25
Last Update Date:2013-04-09
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
312598Medicare Oscar/Certification