1639132608 NPI number — TOTAL RENAL CARE INC

Table of content: (NPI 1639132608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639132608 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:
UNION CITY 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:
1639132608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2019
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:
615-341-6789
Provider Business Mailing Address Fax Number:
866-393-0702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32930 ALVARADO NILES RD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94587-8101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-489-6996
Provider Business Practice Location Address Fax Number:
510-489-3747
Provider Enumeration Date:
04/10/2006

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 ACCOUNTING OFFICER/ TREASURER
Authorized Official Telephone Number:
253-733-4500

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  140000213 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 140000213 . This is a "STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1639132608 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".