Healthcare Provider Details

I. General information

NPI: 1588890024
Provider Name (Legal Business Name): RAI CARE CENTERS OF CLINTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 OLD ALEXANDRIA FERRY ROAD
CLINTON MD
20735-1865
US

IV. Provider business mailing address

424 CHURCH ST SUITE 1900
NASHVILLE TN
37219-2301
US

V. Phone/Fax

Practice location:
  • Phone: 615-661-1100
  • Fax: 615-507-3300
Mailing address:
  • Phone: 615-777-8201
  • Fax:

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier419813100
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name: THOMAS L. WEINBERG
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 214-736-2700