Provider Demographics
NPI:1831534965
Name:RELIANT RENAL CARE KENNER HOME CHOICE, LLC
Entity type:Organization
Organization Name:RELIANT RENAL CARE KENNER HOME CHOICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDNAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-892-4700
Mailing Address - Street 1:1400 N PROVIDENCE RD
Mailing Address - Street 2:BUILDING 2 SUITE 1040
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2043
Mailing Address - Country:US
Mailing Address - Phone:610-892-4700
Mailing Address - Fax:610-892-9760
Practice Address - Street 1:3409 WILLIAMS BLVD
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3700
Practice Address - Country:US
Practice Address - Phone:610-892-4700
Practice Address - Fax:610-892-9760
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELIANT RENAL CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-02
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2398121Medicaid
LA2398121Medicaid