Provider Demographics
NPI:1871956276
Name:DAVITA CKD DIETITIANS, LLC
Entity type:Organization
Organization Name:DAVITA CKD DIETITIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF SPECIAL PROJECTS
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:MANICHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-941-7463
Mailing Address - Street 1:601 HAWAII ST
Mailing Address - Street 2:JLD/SECGOVFIN
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 16TH ST
Practice Address - Street 2:JLD/SECGOVFIN
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-5117
Practice Address - Country:US
Practice Address - Phone:303-876-6438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1018836133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty