Provider Demographics
NPI:1770513400
Name:RENAL NURSE ASSOCIATES, LLC
Entity type:Organization
Organization Name:RENAL NURSE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ANTONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CNN, CEO
Authorized Official - Phone:303-355-5644
Mailing Address - Street 1:8340 EVERETT WAY
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-2211
Mailing Address - Country:US
Mailing Address - Phone:303-355-5644
Mailing Address - Fax:303-355-5059
Practice Address - Street 1:1440 VINE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-2016
Practice Address - Country:US
Practice Address - Phone:303-355-5644
Practice Address - Fax:303-355-5059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0997261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60652021Medicaid
CO062539Medicare ID - Type Unspecified