Provider Demographics
NPI:1932118460
Name:RAI CARE CENTERS OF NORTH CAROLINA II, LLC
Entity Type:Organization
Organization Name:RAI CARE CENTERS OF NORTH CAROLINA II, LLC
Other - Org Name:RAI-GLENWATER-CHARLOTTE
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUNDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-507-3307
Mailing Address - Street 1:1550 W. MCEWEN DRIVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1731
Mailing Address - Country:US
Mailing Address - Phone:615-661-1100
Mailing Address - Fax:615-507-3300
Practice Address - Street 1:9030 GLENWATER DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8563
Practice Address - Country:US
Practice Address - Phone:704-503-6900
Practice Address - Fax:704-503-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2011-02-10
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
NC7494342OtherAETNA
NC2164870OtherCIGNA HEALTHCARE
NC3412591Medicaid
NC001G3OtherBCBS
NC3412591Medicaid