Healthcare Provider Details

I. General information

NPI: 1760443048
Provider Name (Legal Business Name): TOTAL RENAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 W WHITTIER BLVD
MONTEBELLO CA
90640-4004
US

IV. Provider business mailing address

5200 VIRGINIA WAY STE 400 L&C
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 323-722-1116
  • Fax: 323-722-5501
Mailing address:
  • Phone: 615-320-4435
  • Fax: 303-209-7821

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 StateCA

VIII. Authorized Official

Name: THOMAS O USILTON JR.
Title or Position: GROUP VICE PRESIDENT
Credential:
Phone: 615-320-4435