Provider Demographics
NPI:1265743702
Name:RELIANT RENAL CARE LOUISIANA LLC
Entity type:Organization
Organization Name:RELIANT RENAL CARE LOUISIANA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDNAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-892-4700
Mailing Address - Street 1:1400 N PROVIDENCE RD
Mailing Address - Street 2:SUITE 1040 BLDG II
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2043
Mailing Address - Country:US
Mailing Address - Phone:610-892-4700
Mailing Address - Fax:610-892-9760
Practice Address - Street 1:707 GRAND CAILLOU RD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70363-2800
Practice Address - Country:US
Practice Address - Phone:610-892-4700
Practice Address - Fax:610-892-9760
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELIANT RENAL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-30
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment