Healthcare Provider Details

I. General information

NPI: 1699735845
Provider Name (Legal Business Name): TOTAL RENAL CARE EATON CANYON DIALYSIS CENTER PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 E WASHINGTON BLVD
PASADENA CA
91107-1446
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 626-798-8896
  • Fax: 626-398-8279
Mailing address:
  • Phone: 615-341-5895
  • Fax: 866-890-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number930000337
License Number StateCA

VIII. Authorized Official

Name: JAMES K HILGER
Title or Position: CHIEF ACCOUNTING OFFICER
Credential:
Phone: 253-733-4500