Healthcare Provider Details

I. General information

NPI: 1720072093
Provider Name (Legal Business Name): RENAL CARE OF WARREN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W CRESCENT PARK
WARREN PA
16365-2111
US

IV. Provider business mailing address

1641 SASSAFRAS ST
ERIE PA
16502-1858
US

V. Phone/Fax

Practice location:
  • Phone: 814-728-5570
  • Fax: 814-728-5574
Mailing address:
  • Phone: 814-455-6455
  • Fax: 814-456-1188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. ALETHEA G. CASSIDY
Title or Position: CEO
Credential:
Phone: 814-455-6455