Provider Demographics
NPI:1982642401
Name:RENAL CENTER OF PASSAIC, LLC
Entity Type:Organization
Organization Name:RENAL CENTER OF PASSAIC, 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 1:10 CLIFTON BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-3802
Practice Address - Country:US
Practice Address - Phone:973-594-9100
Practice Address - Fax:973-594-9119
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENAL VENTURES MANAGEMENT , LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-04
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22618261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8219401Medicaid
NJ312553Medicare Oscar/Certification