Renviva LLC

NPI #1962873919 in Rockford, Illinois

Provider Information

NPI Number: 1962873919
Entity Type: Organization
Organization Name: Renviva LLC
Primary Specialty: Clinic/Center - End-Stage Renal Disease (ESRD) Treatment
Enumeration Date: Oct 16, 2015
Last Updated: Sep 26, 2016

Practice Location

Address: 1235 N MULFORD RD
City: Rockford
State: Illinois
ZIP Code: 61107-3879
Phone: (513) 673-5245

Authorized Official

Name: MS. SANDRA DIANE FRITZSCH
Title: MEMBER MANAGER
Phone: (513) 673-5245

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment — End-Stage Renal Disease (ESRD) Treatment	261QE0700X	Primary

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