Healthcare Provider Details

I. General information

NPI: 1417055542
Provider Name (Legal Business Name): RELIANT RENAL CARE - MT. MORRIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 N SAGINAW RD
MOUNT MORRIS MI
48458-2131
US

IV. Provider business mailing address

7220 N SAGINAW RD
MOUNT MORRIS MI
48458-2131
US

V. Phone/Fax

Practice location:
  • Phone: 810-687-6837
  • Fax: 810-687-6935
Mailing address:
  • Phone: 810-687-6837
  • Fax: 810-687-6935

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: BARRY L. BLANTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 781-699-9000