Organization
TOTAL RENAL CARE INC
Active
Other names
Raven Rock Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (SR DIRECTOR LICENSURE&CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
483 GATEWAY INDUSTRIAL PARK, JENKINS, KY 41537-9209
(606) 832-2070
(606) 832-2345
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 238-3051
(800) 246-8346
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
300155
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100000450
—
KY
Enumeration date
04/20/2006
Last updated
09/25/2023
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