Organization
RENVIVA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SANDRA DIANE FRITZSCH (MEMBER MANAGER)
(513) 673-5245
Entity
Organization
Contact information
Practice address
1235 N MULFORD RD, ROCKFORD, IL 61107-3879
(513) 673-5245
(866) 352-4339
Mailing address
1235 N MULFORD RD, ROCKFORD, IL 61107-3879
(513) 673-5245
(866) 352-4333
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
10/16/2015
Last updated
09/26/2016
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