1720269996 NPI number — TOTAL RENAL CARE INC

Table of content: (NPI 1720269996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720269996 NPI number — TOTAL RENAL CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL RENAL CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JOY OF DIXON DIALYSIS CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720269996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5200 VIRGINIA WAY
Provider Second Line Business Mailing Address:
L&C DEPT
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-7569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-341-5826
Provider Business Mailing Address Fax Number:
855-330-5768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1640 N LINCOLN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DIXON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95620-9268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-693-8301
Provider Business Practice Location Address Fax Number:
707-693-8306
Provider Enumeration Date:
11/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HILGER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CHIEF ACCT OFFICER
Authorized Official Telephone Number:
253-733-4500

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  550000786 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1720269996 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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