Provider Demographics
NPI:1023487535
Name:REDICLINIC OF DE, LLC
Entity type:Organization
Organization Name:REDICLINIC OF DE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZOREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-975-5937
Mailing Address - Street 1:9 GREENWAY PLZ
Mailing Address - Street 2:STE. 2950
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0905
Mailing Address - Country:US
Mailing Address - Phone:713-335-1754
Mailing Address - Fax:713-358-4870
Practice Address - Street 1:1718 MARSH RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4606
Practice Address - Country:US
Practice Address - Phone:713-335-1754
Practice Address - Fax:713-358-4870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center