Healthcare Provider Details

I. General information

NPI: 1194791046
Provider Name (Legal Business Name): RENAL TREATMENT CENTERS NORTHEAST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W LEA BLVD G-2
WILMINGTON DE
19802-2541
US

IV. Provider business mailing address

5200 VIRGINIA WAY STE 400
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 302-762-8585
  • Fax: 302-762-8586
Mailing address:
  • Phone: 615-320-4521
  • Fax: 866-594-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS O USILTON JR.
Title or Position: GROUP VICE PRESIDENT
Credential:
Phone: 770-541-7922