Healthcare Provider Details

I. General information

NPI: 1861567620
Provider Name (Legal Business Name): GAREY DIALYSIS CENTER PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W FOOTHILL BLVD
GLENDORA CA
91741-3364
US

IV. Provider business mailing address

120 W FOOTHILL BLVD
GLENDORA CA
91741-3364
US

V. Phone/Fax

Practice location:
  • Phone: 626-335-7551
  • Fax: 626-335-0962
Mailing address:
  • Phone: 626-335-7551
  • Fax: 626-335-0962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier052820
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerBLUE CROSS OF CALIFORNIA
# 2
IdentifierCDC02820F
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer
# 3
Identifier052820
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerPTAN
# 4
IdentifierZZZR0223Z
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerBLUE SHIELD OF CALIFORNIA

VIII. Authorized Official

Name: BARRY L. BLANTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 781-699-9000