Healthcare Provider Details

I. General information

NPI: 1023487535
Provider Name (Legal Business Name): REDICLINIC OF DE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 03/21/2020
Certification Date: 03/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 MARSH RD
WILMINGTON DE
19810-4606
US

IV. Provider business mailing address

9 GREENWAY PLZ STE. 2950
HOUSTON TX
77046-0905
US

V. Phone/Fax

Practice location:
  • Phone: 713-335-1754
  • Fax: 713-358-4870
Mailing address:
  • Phone: 713-335-1754
  • Fax: 713-358-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER M ZOREK
Title or Position: SR MANAGER
Credential:
Phone: 717-975-5937