Provider Demographics
NPI:1801842182
Name:RENAL CENTER OF BRICK, LLC
Entity Type:Organization
Organization Name:RENAL CENTER OF BRICK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-384-4000
Mailing Address - Street 1:1626 COLE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3306
Mailing Address - Country:US
Mailing Address - Phone:303-384-4000
Mailing Address - Fax:303-273-5991
Practice Address - Street 1:150 BRICK BOULEVARD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7125
Practice Address - Country:US
Practice Address - Phone:732-477-2247
Practice Address - Fax:732-477-3479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENAL VENTURES MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-26
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22820261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8956103Medicaid
NJ312563Medicare Oscar/Certification