Provider Demographics
NPI:1891804928
Name:DCA OF BARNWELL LLC
Entity Type:Organization
Organization Name:DCA OF BARNWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT & SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-736-2732
Mailing Address - Street 1:PO BOX 713158
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45271-3158
Mailing Address - Country:US
Mailing Address - Phone:717-730-9701
Mailing Address - Fax:717-730-6223
Practice Address - Street 1:10708 MARLBORO AVENUE
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812
Practice Address - Country:US
Practice Address - Phone:830-541-7225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U S RENAL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCERD-179261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCERD179Medicaid
SCERD179Medicaid